Provider Demographics
NPI:1447085881
Name:MDAK LLC
Entity type:Organization
Organization Name:MDAK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YANN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODENAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:765-702-1557
Mailing Address - Street 1:821 COURT ST STE A
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1763
Mailing Address - Country:US
Mailing Address - Phone:603-352-1993
Mailing Address - Fax:
Practice Address - Street 1:821 COURT ST STE A
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1763
Practice Address - Country:US
Practice Address - Phone:603-352-1993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental