| Randolph & Associates Family Dentistry | |
|
119 N Williamsburg Dr Bloomington IL 61704-3528 | |
| (309) 663-1326 | |
| Not Available |
| Full Name | Randolph & Associates Family Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 119 N Williamsburg Dr, Bloomington, Illinois |
| Authorized Official Name and Position | Jenny Garcia-rocha (SR CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 9728693789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Randolph & Associates Family Dentistry 119 N Williamsburg Dr Bloomington IL 61704-3528 | Randolph & Associates Family Dentistry 119 N Williamsburg Dr Bloomington IL 61704-3528 Ph: (309) 663-1326 |
| NPI Number | 1104639004 |
|---|---|
| Provider Enumeration Date | 01/27/2025 |
| Last Update Date | 07/16/2025 |
| Certification Date | 07/16/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104639004 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | () | Primary |
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