Healthcare Provider Details

I. General information

NPI: 1386146512
Provider Name (Legal Business Name): MADALYN SUZANNE DUPLESSIS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2018
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2442 MOUNDS VIEW BLVD
SAINT PAUL MN
55112-1478
US

IV. Provider business mailing address

2442 MOUNDS VIEW BLVD
SAINT PAUL MN
55112-1478
US

V. Phone/Fax

Practice location:
  • Phone: 763-316-5400
  • Fax:
Mailing address:
  • Phone: 763-316-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD14143
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: