Randall Lee Breeden, D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

08190 Issued in IA

Practice address

2928 Hamilton Blvd
Suite 101
Sioux City, IA 51104-2424

Phone

(712) 258-3636

Fax

(712) 255-4163

NPI assigned

Jan 5, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michael Wheatley DDS of South Dakota PC

  • Endodontics
  • Yankton, SD
  • NPI 1427561042
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1194873315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2928 HAMILTON BLVD",
            "address_2": "SUITE 101",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511042424",
            "telephone_number": "712-258-3636",
            "fax_number": "712-255-4163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2928 HAMILTON BLVD",
            "address_2": "SUITE 101",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511042424",
            "telephone_number": "712-258-3636",
            "fax_number": "712-255-4163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREEDEN",
        "first_name": "RANDALL",
        "middle_name": "LEE",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "IA",
            "license": "08190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "34813",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0436113",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Boys and Girls Home and Family Services, Inc.
• Boys and Girls Home Residential Treatment Centers, Inc.
• Nabil Braiteh, MD
• Heidi Braunschweig, ARNP
• Yorbelis Brea
• Kayla Breems, PHARM D
• Julie Ann Breiner, M.D.
• Lance D Breit, CRNA
• Cortnie Breitbarth
• Dakota Bryce Bremser, ARNP

• Endodontics in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Endodontics in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.