Healthcare Provider Details

I. General information

NPI: 1144912239
Provider Name (Legal Business Name): MADISON N MCQUITTY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 GARFIELD ST
SANTA FE NM
87501-2612
US

IV. Provider business mailing address

308 GARFIELD ST
SANTA FE NM
87501-2612
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-9888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDB-2023-0081
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: