Provider Demographics
NPI:1891861811
Name:BURNIGHT, RANDALL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:L
Last Name:BURNIGHT
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 1:5402 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-3136
Mailing Address - Country:US
Mailing Address - Phone:712-276-8432
Mailing Address - Fax:712-276-4144
Practice Address - Street 1:5402 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-3136
Practice Address - Country:US
Practice Address - Phone:712-276-8432
Practice Address - Fax:712-276-4144
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0144790Medicaid