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General NPI Number Information
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NPI Number | 1164624433
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Entity Type | Individual
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Provider Name | MATTHEW JAMES MADSEN D.M.D, M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 08/28/2013
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Provider Practice Location Address
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Address Line | 839 E GRAND AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-3401
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Country | US
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Telephone | 859-806-3925
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Fax |
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Provider Business Mailing Address
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Address Line | 839 E GRAND AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-3401
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Country | US
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Telephone | 859-806-3925
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 8480
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 62546
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | A125274
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License Number State | CA
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