Provider Demographics
NPI:1104574599
Name:BAGNELL, MAKENZIE NICOLE (DDS)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:NICOLE
Last Name:BAGNELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:NICOLE
Other - Last Name:THURINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:33 DOC KIMBALL WAY
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-6491
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 DOC KIMBALL WAY
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-6491
Practice Address - Country:US
Practice Address - Phone:406-614-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MTDEN-DEN-LIC-23639122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program