MEDICARE: DR. GARY ADDISON MADISON DDS

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	122300000X	Dentist	26471	CA

General Provider Information

NPI Number	:	1336134956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY ADDISON MADISON DDS

Provider Business Mailing Address
First Line	:	1411 LISA WAY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92027-1172
Country	:	US
Telephone Number	:	760-745-6202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 LISA WAY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92027-1172
Country	:	US
Telephone Number	:	760-745-6202
Fax Number	:

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	03/04/2009

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