Provider Demographics
NPI:1720189202
Name:DAYNES, DAVID RANDALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RANDALL
Last Name:DAYNES
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 1:155 S STATE ST STE A
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-2031
Mailing Address - Country:US
Mailing Address - Phone:801-785-5383
Mailing Address - Fax:801-796-9370
Practice Address - Street 1:155 S STATE ST STE A
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-2031
Practice Address - Country:US
Practice Address - Phone:801-785-5383
Practice Address - Fax:801-796-9370
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT344831-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT20-2806440OtherTAX ID
UT46-1733553OtherTAX ID