Provider Demographics
NPI:1629831813
Name:FRANDSEN, RYAN GLEN (RDH)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:GLEN
Last Name:FRANDSEN
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 W CRAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7326
Mailing Address - Country:US
Mailing Address - Phone:435-979-3408
Mailing Address - Fax:
Practice Address - Street 1:10458 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8501
Practice Address - Country:US
Practice Address - Phone:801-312-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13779254-9920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist