Provider Demographics
NPI:1295852697
Name:HOUSKA, RANDY GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:GEORGE
Last Name:HOUSKA
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 1:1302 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-2813
Mailing Address - Country:US
Mailing Address - Phone:605-624-3031
Mailing Address - Fax:605-624-8084
Practice Address - Street 1:1302 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-2813
Practice Address - Country:US
Practice Address - Phone:605-624-3031
Practice Address - Fax:605-624-8084
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM7241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice