Provider Demographics
NPI:1780754036
Name:HESTIR, RANDALL S (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:S
Last Name:HESTIR
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 1:1703 S WHITEHEAD DR
Mailing Address - Street 2:PO DRAWER 512
Mailing Address - City:DEWITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042
Mailing Address - Country:US
Mailing Address - Phone:870-946-2013
Mailing Address - Fax:870-946-1281
Practice Address - Street 1:1703 S WHITEHEAD DR
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:AR
Practice Address - Zip Code:72042
Practice Address - Country:US
Practice Address - Phone:870-946-2013
Practice Address - Fax:870-946-1281
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO22661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice