Provider Demographics
NPI:1780815365
Name:SANOVICH, RANDY ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:ROBERT
Last Name:SANOVICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12740 HILLCREST RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2050
Mailing Address - Country:US
Mailing Address - Phone:972-776-4888
Mailing Address - Fax:972-338-7001
Practice Address - Street 1:12740 HILLCREST RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2050
Practice Address - Country:US
Practice Address - Phone:972-776-4888
Practice Address - Fax:972-833-7001
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX295141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery