Provider Demographics
NPI:1093008518
Name:MADDEN, DENNIS J (RD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:MADDEN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 TROOP DR UNIT 105A
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4733
Mailing Address - Country:US
Mailing Address - Phone:320-217-8480
Mailing Address - Fax:320-217-8490
Practice Address - Street 1:2330 TROOP DR UNIT 105A
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4733
Practice Address - Country:US
Practice Address - Phone:320-217-8480
Practice Address - Fax:320-217-8490
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2895133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered