Provider Demographics
NPI:1215068861
Name:RICHARD J RAND JR DMD PA
Entity type:Organization
Organization Name:RICHARD J RAND JR DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-639-8030
Mailing Address - Street 1:428 E OLYMPIA AVE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3836
Mailing Address - Country:US
Mailing Address - Phone:941-639-8030
Mailing Address - Fax:941-639-1901
Practice Address - Street 1:428 E OLYMPIA AVE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3836
Practice Address - Country:US
Practice Address - Phone:941-639-8030
Practice Address - Fax:941-639-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN69651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
609637OtherUNITED CONCORDIA
MAZ09609OtherBCBS MA
FL66372OtherBCBS FL