Provider Demographics
NPI:1558477208
Name:HOBBS, RANDALL CLIFFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:CLIFFORD
Last Name:HOBBS
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 1:9614 N 6220 W
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:UT
Mailing Address - Zip Code:84003-3404
Mailing Address - Country:US
Mailing Address - Phone:801-471-7397
Mailing Address - Fax:
Practice Address - Street 1:150 E CENTER ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3106
Practice Address - Country:US
Practice Address - Phone:801-371-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5403624-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice