MEDICARE: DR. ERIC COLE MACFADDEN DMD

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	019.036962	IL
2	1223G0001X	General Practice Dentistry	6002072-15	WI

General Provider Information

NPI Number	:	1205771300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC COLE MACFADDEN DMD

Provider Business Mailing Address
First Line	:	2511A S LOGAN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-1835
Country	:	US
Telephone Number	:	740-751-2765
Fax Number	:

Provider Business Practice Location Address
First Line	:	2511A S LOGAN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-1835
Country	:	US
Telephone Number	:	740-751-2765
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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