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General NPI Number Information
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NPI Number | 1043586019
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Entity Type | Organization
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Legal Business Name | DR. THERESA E. MADDEN & ASSOCIATES, PLLC
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 304 W BAY DR NW SUITE 201
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City | OLYMPIA
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State | WA
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Zip | 98502-4953
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Country | US
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Telephone | 360-459-5900
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Fax | 360-459-8720
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Provider Business Mailing Address
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Address Line | 304 W BAY DR NW SUITE 201
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City | OLYMPIA
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State | WA
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Zip | 98502-4953
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Country | US
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Telephone | 360-459-5900
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Fax | 360-459-8720
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Authorized Official
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Title or Position | OWNER
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Name | DR. THERESA E. MADDEN
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Credential | DDS, PHD
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Telephone | 360-459-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 00009862
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License Number State | WA
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