Healthcare Provider Details

I. General information

NPI: 1356910251
Provider Name (Legal Business Name): MADISON HOMESLEY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 N GENERALS BLVD STE F
LINCOLNTON NC
28092-3537
US

IV. Provider business mailing address

312 N LAUREL ST
LINCOLNTON NC
28092-2912
US

V. Phone/Fax

Practice location:
  • Phone: 704-748-1110
  • Fax:
Mailing address:
  • Phone: 704-740-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12291
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12291
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: