Individual
KALEB MADSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1601 S SECOND ST, GALLUP, NM 87301-5816
(505) 722-4422
Mailing address
1104 NEVADA CIR, GALLUP, NM 87301-5433
(801) 822-3222
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DB-2025-0111
NM
Other
Enumeration date
07/01/2025
Last updated
07/01/2025
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