Healthcare Provider Details

I. General information

NPI: 1467534206
Provider Name (Legal Business Name): RANDY SEAN BARNHISEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4970 S 900 E STE G
SLC UT
84117-3930
US

IV. Provider business mailing address

4970 S 900 E STE G
SLC UT
84117-3930
US

V. Phone/Fax

Practice location:
  • Phone: 801-262-6811
  • Fax: 801-685-2936
Mailing address:
  • Phone: 801-262-6811
  • Fax: 801-685-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number51403459922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: