Provider Demographics
NPI:1962922286
Name:RANDALL, KAREN AMANDA (DMD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:AMANDA
Last Name:RANDALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:AMANDA
Other - Last Name:MACHADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1828 LOST CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101
Mailing Address - Country:US
Mailing Address - Phone:520-360-3475
Mailing Address - Fax:
Practice Address - Street 1:2900 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-8626
Practice Address - Country:US
Practice Address - Phone:406-656-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-134601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice