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Contact Information

JAY S RANDELL, DMD
530 NW 27TH ST
CORVALLIS, OR97330-5223
 Phone: 541-766-0123
 Fax: 541-766-6186
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dental Public Health

1223D0001X
 

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for JAY S RANDELL · (Male)

NPI # 1437231503
Status Active
Credentials DMD (Doctor of Medical Dentistry)
Entity Individual
Enumeration date 10/19/2006
Last updated 12/31/2019 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • CO License # 202368
  • FL License # 13269
  • NY License # 044249
  • OR License # D11182
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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