Individual
KENDRA JEAN DESIREE HACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2901 BROOKS ST, MISSOULA, MT 59801-7703
(406) 541-2886
Mailing address
3960 S LAKE DR UNIT 7, ST FRANCIS, WI 53235-5217
(617) 697-7161
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1002640-15
WI
1223G0001X
General Practice Dentistry
Primary
25907
MT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/30/2021
Last updated
07/10/2023
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