Provider Demographics
NPI:1124821921
Name:PEREZ-PADILLA, RANDY (DMD)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:PEREZ-PADILLA
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 NW 170TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3806
Mailing Address - Country:US
Mailing Address - Phone:786-448-0221
Mailing Address - Fax:
Practice Address - Street 1:1737 N 2000 W STE G
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8215
Practice Address - Country:US
Practice Address - Phone:801-728-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-28
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT14213045-99261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program