Healthcare Provider Details

I. General information

NPI: 1386376697
Provider Name (Legal Business Name): MADELEINE TAWADROS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8031 LINDA VISTA RD STE 200
SAN DIEGO CA
92111-5110
US

IV. Provider business mailing address

9166 SAN JUAN PL
LA MESA CA
91941-5644
US

V. Phone/Fax

Practice location:
  • Phone: 844-632-6631
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS111251
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.026887
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: