Provider Demographics
NPI:1457323719
Name:MADSEN, KENNETH A JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:MADSEN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1035 1ST AVE. WEST
Mailing Address - Street 2:FLATHEAD COMMUNITY HEALTH CENTER
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5607
Mailing Address - Country:US
Mailing Address - Phone:406-751-8155
Mailing Address - Fax:406-751-8151
Practice Address - Street 1:1035 1ST AVE WEST
Practice Address - Street 2:FLATHEAD COMMUNITY HEALTH CENTER
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5607
Practice Address - Country:US
Practice Address - Phone:406-751-8155
Practice Address - Fax:406-751-8151
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT16341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice