Basic Information
| Provider Information | |||||||||
| NPI: | 1588068878 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANDA | ||||||||
| FirstName: | LACEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 SW HUNTOON ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666041231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858618800 | ||||||||
| FaxNumber: | 7854785991 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 SW HUNTOON ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666041231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858618800 | ||||||||
| FaxNumber: | 7854785991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2014 | ||||||||
| LastUpdateDate: | 04/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 8454 | SC | N | Dental Providers | Dentist | General Practice | 1223G0001X | 61248 | KS | Y | Dental Providers | Dentist | General Practice |
No ID Information.