Healthcare Provider Details

I. General information

NPI: 1174818629
Provider Name (Legal Business Name): BENJAMIN RONALD FRANDSEN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E 800 N STE 101
OREM UT
84097-4436
US

IV. Provider business mailing address

1375 E 800 N STE 101
OREM UT
84097-4436
US

V. Phone/Fax

Practice location:
  • Phone: 801-375-3355
  • Fax: 801-224-7374
Mailing address:
  • Phone: 801-375-3355
  • Fax: 801-224-7374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7721150-9921
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: