Provider Demographics
NPI:1013220326
Name:MADSEN, MICHAEL OGDEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:OGDEN
Last Name:MADSEN
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 1:10834 SPLENDOR LOOP
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8197
Mailing Address - Country:US
Mailing Address - Phone:801-787-0982
Mailing Address - Fax:
Practice Address - Street 1:4951 BUSINESS PARK BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7174
Practice Address - Country:US
Practice Address - Phone:907-743-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-15
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice