MEDICARE: PETER CHARLES MADDEN DDS INC

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	1223G0001X	General Practice Dentistry	30 . 019683	OH

General Provider Information

NPI Number	:	1154451789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER CHARLES MADDEN DDS INC

Provider Business Mailing Address
First Line	:	6839 WOOSTER PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-4328
Country	:	US
Telephone Number	:	513-271-6322
Fax Number	:	513-271-6373

Provider Business Practice Location Address
First Line	:	6839 WOOSTER PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45227-4328
Country	:	US
Telephone Number	:	513-271-6322
Fax Number	:	513-271-6373

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER CHARLES MADDEN
Credential	:	DDS
Telephone Number	:	513-271-6322

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2020

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