Individual
RANDALL LEE BREEDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2928 HAMILTON BLVD, SUITE 101, SIOUX CITY, IA 51104-2424
(712) 258-3636
(712) 255-4163
Mailing address
2928 HAMILTON BLVD, SUITE 101, SIOUX CITY, IA 51104-2424
(712) 258-3636
(712) 255-4163
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
08190
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0436113
—
IA
01
—
34813
BLUE CROSS
IA
Enumeration date
01/05/2007
Last updated
07/09/2007
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