Basic Information
| Provider Information | |||||||||
| NPI: | 1356495394 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADJARAC | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2513 BENT OAK CT | ||||||||
| Address2: | |||||||||
| City: | PLATTE CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640797625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397241 | ||||||||
| FaxNumber: | 7852397245 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 POPE AVENUE | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY | ||||||||
| City: | FT. LEAVENWORTH | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397241 | ||||||||
| FaxNumber: | 7852397245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 021957 | OH | Y | Dental Providers | Dentist |
No ID Information.