Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 33193 | TX |
NPI | 1003263948 |
---|---|
Provider Name | Dr. Chandy Ann Randall |
First Address | Frisco, TX 75035-7869 |
Second Address | Frisco, TX 75035-7869 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2016 |
Last Update Date | 13/07/2017 |