Provider Demographics
NPI:1063516128
Name:BITTNER, RANDALL L (DMD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:L
Last Name:BITTNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 ALLIE NICOLE CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-7010
Mailing Address - Country:US
Mailing Address - Phone:757-573-8448
Mailing Address - Fax:
Practice Address - Street 1:1930 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4373
Practice Address - Country:US
Practice Address - Phone:757-922-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010080301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice