Provider Demographics
NPI:1871519256
Name:SULZER, RANDALL JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JAY
Last Name:SULZER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3664 CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1202
Mailing Address - Country:US
Mailing Address - Phone:619-225-8217
Mailing Address - Fax:
Practice Address - Street 1:7854 GOLDEN AVE
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1804
Practice Address - Country:US
Practice Address - Phone:619-463-4459
Practice Address - Fax:619-463-7415
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0338541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice