Provider Demographics
NPI:1861409492
Name:BADGER, MICHAEL EUGENE (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EUGENE
Last Name:BADGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 E LEWIS AND CLARK PKWY
Mailing Address - Street 2:GREEN TREE MALL DENTAL BLDG
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-2269
Mailing Address - Country:US
Mailing Address - Phone:812-288-6681
Mailing Address - Fax:
Practice Address - Street 1:757 E LEWIS AND CLARK PKWY
Practice Address - Street 2:GREEN TREE MALL DENTAL BLDG
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2269
Practice Address - Country:US
Practice Address - Phone:812-288-6681
Practice Address - Fax:812-288-6733
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007970A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics