Provider Demographics
NPI:1851372940
Name:ADDINK, KEN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:L
Last Name:ADDINK
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 1:159 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-1535
Mailing Address - Country:US
Mailing Address - Phone:712-722-2618
Mailing Address - Fax:712-722-2638
Practice Address - Street 1:159 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1535
Practice Address - Country:US
Practice Address - Phone:712-722-2618
Practice Address - Fax:712-722-2638
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA62321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0146829Medicaid
IA0739029OtherMEDICAID GROUP ID