Healthcare Provider Details

I. General information

NPI: 1124821921
Provider Name (Legal Business Name): RANDY PEREZ-PADILLA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 N 2000 W STE G
CLINTON UT
84015-8215
US

IV. Provider business mailing address

7901 NW 170TH ST
HIALEAH FL
33015-3806
US

V. Phone/Fax

Practice location:
  • Phone: 801-728-9000
  • Fax:
Mailing address:
  • Phone: 786-448-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14213045-9926
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: