Provider Demographics
NPI:1427492834
Name:RANDALL T CALIFF DDS PA
Entity type:Organization
Organization Name:RANDALL T CALIFF DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:CALIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-432-1841
Mailing Address - Street 1:2740 LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3686
Mailing Address - Country:US
Mailing Address - Phone:954-432-1841
Mailing Address - Fax:954-430-1622
Practice Address - Street 1:12578 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323
Practice Address - Country:US
Practice Address - Phone:954-851-9829
Practice Address - Fax:954-851-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60993OtherBCBS
FL1124244470OtherINDIVIUAL NPI
FL9027OtherDELTA DENTAL