Breeden, Randall Lee

Breeden, Randall Lee is an individual health care provider with primary practice located at 2928 Hamilton Blvd Suite 101, Sioux City IA 51104-2424. He recently has only one registered license in Dental Providers / Endodontics, which is considered as his primary health care specialty. Breeden, Randall Lee can be contacted via phone (712) 258-3636.

Contact Information

Primary practice address
2928 Hamilton Blvd Suite 101 Sioux City IA 51104-2424
Phone: (712) 258-3636
Fax: (712) 255-4163
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Endodontics 1223E0200X 08190 Iowa

Profile Details

NPI number 1194873315
LBN Legal business name Breeden, Randall Lee
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 5th, 2007
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194873315 NPPES
Iowa Other 34813 BLUE CROSS
Iowa MEDICAID 0436113 BLUE CROSS

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