Individual
DR. KEN L ADDINK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
159 S MAIN AVE, SIOUX CENTER, IA 51250-1535
(712) 722-2618
(712) 722-2638
Mailing address
159 S MAIN AVE, SIOUX CENTER, IA 51250-1535
(712) 722-2618
(712) 722-2638
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6232
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0146829
—
IA
01
—
0739029
MEDICAID GROUP ID
IA
Enumeration date
11/07/2005
Last updated
01/29/2008
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