MEDICARE: MR. KENNETH A BUDKE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	05833	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457410326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH A BUDKE DDS

Provider Business Mailing Address
First Line	:	3217 CEDAR HEIGHTS DRIVE
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613
Country	:	US
Telephone Number	:	319-277-6921
Fax Number	:	319-859-2007

Provider Business Practice Location Address
First Line	:	3217 CEDAR HEIGHTS DRIVE
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613
Country	:	US
Telephone Number	:	319-277-6921
Fax Number	:	319-859-2007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	07/08/2007

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