Provider Demographics
NPI:1467534206
Name:BARNHISEL, RANDY SEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:SEAN
Last Name:BARNHISEL
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 1:4970 S 900 E STE G
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84117-3930
Mailing Address - Country:US
Mailing Address - Phone:801-262-6811
Mailing Address - Fax:801-685-2936
Practice Address - Street 1:4970 S 900 E STE G
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84117-3930
Practice Address - Country:US
Practice Address - Phone:801-262-6811
Practice Address - Fax:801-685-2936
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT514034599221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice