Healthcare Provider Details

I. General information

NPI: 1689592735
Provider Name (Legal Business Name): MADERE DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N HARBOR DR APT 5001
CHICAGO IL
60601-7352
US

IV. Provider business mailing address

175 N HARBOR DR APT 5001
CHICAGO IL
60601-7352
US

V. Phone/Fax

Practice location:
  • Phone: 312-623-2363
  • Fax:
Mailing address:
  • Phone: 312-623-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN MADERE
Title or Position: DENTIST
Credential: DMD
Phone: 312-623-2363