Provider Demographics
NPI:1912244815
Name:HOGHAUG, RANDAHL BURGESS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDAHL
Middle Name:BURGESS
Last Name:HOGHAUG
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 1:1019 CAMP JIM RD. S.W.
Mailing Address - Street 2:
Mailing Address - City:PILLAGER
Mailing Address - State:MN
Mailing Address - Zip Code:56473
Mailing Address - Country:US
Mailing Address - Phone:218-828-8055
Mailing Address - Fax:
Practice Address - Street 1:1019 CAMP JIM RD. S.W.
Practice Address - Street 2:
Practice Address - City:PILLAGER
Practice Address - State:MN
Practice Address - Zip Code:56473
Practice Address - Country:US
Practice Address - Phone:218-828-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND7314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist