Healthcare Provider Details

I. General information

NPI: 1013851831
Provider Name (Legal Business Name): MADELINE CARDINAL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 BOATNER RD BLDG 2751
EGLIN AFB FL
32542-1391
US

IV. Provider business mailing address

340 BOATNER RD BLDG 2751
EGLIN AFB FL
32542-1391
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-8324
  • Fax:
Mailing address:
  • Phone: 850-883-8324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901602992
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: