Individual
RANDAL ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6321 S REDWOOD RD STE 206, TAYLORSVILLE, UT 84123-6972
(801) 494-9839
Mailing address
6321 S REDWOOD RD STE 206, TAYLORSVILLE, UT 84123-6972
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
5501438-8903
UT
1223G0001X
General Practice Dentistry
Primary
5501438-9922
UT
Other
Enumeration date
09/20/2011
Last updated
09/20/2011
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