Healthcare Provider Details

I. General information

NPI: 1639707649
Provider Name (Legal Business Name): TRENT DUANE MADSEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 E BATTLEFIELD ST
SPRINGFIELD MO
65804-4016
US

IV. Provider business mailing address

2910 E BATTLEFIELD ST
SPRINGFIELD MO
65804-4016
US

V. Phone/Fax

Practice location:
  • Phone: 417-444-6776
  • Fax:
Mailing address:
  • Phone: 417-444-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2020014879
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: