Provider Demographics
NPI:1871614065
Name:RANDISH, JOAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:M
Last Name:RANDISH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 102ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5676
Mailing Address - Country:US
Mailing Address - Phone:425-451-8609
Mailing Address - Fax:425-453-0982
Practice Address - Street 1:25 102ND AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5676
Practice Address - Country:US
Practice Address - Phone:425-451-8609
Practice Address - Fax:425-453-0982
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist