Provider Demographics
NPI:1588786313
Name:CAROL RANDOLPH WALD DDS PC
Entity type:Organization
Organization Name:CAROL RANDOLPH WALD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:WALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-617-3322
Mailing Address - Street 1:101 AUSTIN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-4660
Mailing Address - Country:US
Mailing Address - Phone:972-617-3322
Mailing Address - Fax:
Practice Address - Street 1:101 AUSTIN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-4660
Practice Address - Country:US
Practice Address - Phone:972-617-3322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty