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GREGORY M RANDOLPH DDS & ASSOCIATES, LTD
NPI 1104639004
Dentist - General Practice in Bloomington, IL

Active since January 27, 2025
119 N WILLIAMSBURG DR, BLOOMINGTON, IL 61704(309) 663-1326 Get Directions Write a Review

NPPES record last updated: July 16, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Gregory M Randolph Dds & Associates, Ltd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREGORY M RANDOLPH DDS & ASSOCIATES, LTD (NPI 1104639004), doing business as Randolph & Associates Family Dentistry, is a healthcare organization registered as a general practice in Bloomington, Illinois and active in the NPI registry since January 2025. The organization lists Jenny Garcia-rocha, Sr Credentialing Team Lead, as its authorized official.

NPPES Registry Identity

NPI1104639004
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameGREGORY M RANDOLPH DDS & ASSOCIATES, LTD
Location Address119 N WILLIAMSBURG DRBloomington, IL 61704-3528
Mailing Address119 N Williamsburg DrBloomington, IL 61704-3528
Phone(309) 663-1326
Organization SubpartNo
Authorized OfficialJenny Garcia-rochaSr Credentialing Team Lead · (972) 869-3789
Enumeration DateJanuary 27, 2025
Last NPPES UpdateJuly 16, 2025
NPPES CertifiedJuly 16, 2025
✔ NPI 1104639004 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
119 N WILLIAMSBURG DR, Bloomington, IL 61704
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Other Names 1

Doing Business AsRandolph & Associates Family Dentistry

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JACK CHARLES MORKIN
Dentist
119 N WILLIAMSBURG DR
BLOOMINGTON, IL 61704
McLean County (309) 663-1326
DR. GREGORY MARSHALL RANDOLPH D,D.S.
Dentist (General Practice)
119 N WILLIAMSBURG DR
BLOOMINGTON, IL 61704
McLean County (309) 663-1326

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gregory M Randolph Dds & Associates, Ltd's NPI number?

The NPI number for Gregory M Randolph Dds & Associates, Ltd is 1104639004. It was assigned to this organization in the NPPES registry on January 27, 2025. The provider is doing business as Randolph & Associates Family Dentistry.

Where is Gregory M Randolph Dds & Associates, Ltd located?

Gregory M Randolph Dds & Associates, Ltd is located at 119 N Williamsburg Dr, Bloomington, IL 61704. The listed phone number is (309) 663-1326.

What is Gregory M Randolph Dds & Associates, Ltd's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Gregory M Randolph Dds & Associates, Ltd was last updated on July 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.