Provider Demographics
NPI:1053402149
Name:NUNN, RANDALL W (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:W
Last Name:NUNN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7455
Mailing Address - Country:US
Mailing Address - Phone:732-349-9144
Mailing Address - Fax:732-286-6548
Practice Address - Street 1:623 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7455
Practice Address - Country:US
Practice Address - Phone:732-349-9144
Practice Address - Fax:732-286-6548
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101778500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist