Provider Demographics
NPI:1891833547
Name:BART T WATTS DDS RANDALL K JOHNSON DDS INC
Entity Type:Organization
Organization Name:BART T WATTS DDS RANDALL K JOHNSON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:T
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-572-4404
Mailing Address - Street 1:1434 E 9400 SOUTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093
Mailing Address - Country:US
Mailing Address - Phone:801-572-4404
Mailing Address - Fax:801-572-4405
Practice Address - Street 1:1434 E 9400 SOUTH
Practice Address - Street 2:SUITE 200
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093
Practice Address - Country:US
Practice Address - Phone:801-572-4404
Practice Address - Fax:801-572-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1223G0001X
UT14408699221223G0001X
UT14427999221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty