Individual
JAKE MADSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
652 HAMILTON RD., FORT SILL, OK 73503
(580) 442-3905
Mailing address
652 HAMILTON RD., FORT SILL, OK 73503
(580) 442-4002
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9809328-9922
UT
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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