Provider Demographics
NPI:1871618165
Name:NUNLEY, RANDALL (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:NUNLEY
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 1:2843 N 88TH PL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-1463
Mailing Address - Country:US
Mailing Address - Phone:480-220-2642
Mailing Address - Fax:
Practice Address - Street 1:4726 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7712
Practice Address - Country:US
Practice Address - Phone:602-840-2330
Practice Address - Fax:602-840-2379
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice