Healthcare Provider Details

I. General information

NPI: 1265360341
Provider Name (Legal Business Name): RED SEA JOURNEY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 US-89
LOGAN UT
84321
US

IV. Provider business mailing address

3739 CAMINO LAS PALMERAS
SIERRA VISTA AZ
85650-9541
US

V. Phone/Fax

Practice location:
  • Phone: 435-787-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAROM HANSEN
Title or Position: OWNER
Credential: DMD
Phone: 502-901-8490