Healthcare Provider Details

I. General information

NPI: 1720940471
Provider Name (Legal Business Name): MADRIGAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 COFFEE RD STE N
MODESTO CA
95355-4229
US

IV. Provider business mailing address

1213 COFFEE RD STE N
MODESTO CA
95355-4229
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-0833
  • Fax:
Mailing address:
  • Phone: 209-577-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: APOLINAR MADRIGAL
Title or Position: CEO
Credential: DDS
Phone: 209-577-0833