Healthcare Provider Details

I. General information

NPI: 1649408584
Provider Name (Legal Business Name): RACHEL N MADDEN DMD, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SIMON ST STE 11
NASHUA NH
03060-3046
US

IV. Provider business mailing address

39 SIMON ST STE 11
NASHUA NH
03060-3046
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-4008
  • Fax: 603-881-3822
Mailing address:
  • Phone: 603-883-4008
  • Fax: 603-881-3822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number150742
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number04145
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: