DR. RANDALL EDWARD MCKEAN (NPI# 1437296746) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437296746 |
| Entity Type | Individual |
| Full Name | DR. RANDALL EDWARD MCKEAN |
| Credential | D.D.S. |
| Practice Address |
112 N Park Dr Fayetteville GA 30214-1645 |
| Practice Telephone | 7704601527 |
| Mailing Telephone | 7704611959 |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
008058 | GA | Dental Providers |
| Street Address |
112 N PARK DR |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-1645 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992093801 | John Haycock | Dentist | 112 N Park Dr, Fayetteville, GA 30214-1645 | 2011-07-12 |
| 1861539181 | Thomas D Blaney | Dentist | 112 N Park Dr, Fayetteville, GA 30214-1645 | 2007-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497266092 | Kerolos Ragaey Helmy Elsayed | Dentist | 2028 Litho Pl, Fayetteville, NC 28304-2537 | 2017-10-23 |
| 1922523091 | Jamey C. Tinnin D.d.s. Endodontics Ltd | Dentist | 1680 E Joyce Blvd, Fayetteville, AR 72703-6214 | 2017-08-09 |
| 1679961148 | Suren Paravyan, Dmd, Md, Msd, Pa | Dentist | 201 S. Mcpherson Church Rd., Suite 201, Fayetteville, NC 28303 | 2015-01-06 |
| 1144359480 | John Lloyd Phillips | Dentist | 201 S Mcpherson Church Rd Ste 102, Fayetteville, NC 28303-4913 | 2007-03-04 |
| 1003980020 | Bhavik P Shah | Dentist | 1240 Highway 54 W Ste 315, Fayetteville, GA 30214-4572 | 2006-11-20 |
| 1326149618 | East Side Dental Specialists P.C. | Dentist | 7201 E Genesee St, Fayetteville, NY 13066-1262 | 2006-09-26 |
| 1013992932 | William Francis Freccia | Dentist | 1312 Avon St, Fayetteville, NC 28304-4441 | 2005-12-14 |
| 1407372949 | James M. Tinnin, D.d.s., M.s.d, P.a. | Dentist | 1831 N Green Acres Rd, Fayetteville, AR 72703-2615 | 2017-08-16 |
| 1962923268 | Benjamin Lanier Wheeler | Dentist | 1240 Highway 54 W Ste 315, Fayetteville, GA 30214-4572 | 2017-06-28 |
| 1609158153 | Drs. Nathaniel and Katherine Behrents Dds, PC | Dentist | 152 E Appleby Rd, Fayetteville, AR 72703-3903 | 2011-09-11 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 30214 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.