Provider Demographics
NPI:1225279995
Name:JOHNSON, RANDALL KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:KAY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 E 9400 S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-2957
Mailing Address - Country:US
Mailing Address - Phone:801-572-4404
Mailing Address - Fax:801-572-4405
Practice Address - Street 1:1434 E 9400 S
Practice Address - Street 2:SUITE 200
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-2957
Practice Address - Country:US
Practice Address - Phone:801-572-4404
Practice Address - Fax:801-572-4405
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1442791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice