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General NPI Number Information
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NPI Number | 1356036198
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Entity Type | Individual
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Provider Name | MADISON MOORE DMD
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Gender | Female
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 4600 JOHN MARR DR STE 401
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City | ANNANDALE
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State | VA
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Zip | 22003-3310
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Country | US
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Telephone | 703-750-9393
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Fax |
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Provider Business Mailing Address
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Address Line | 2803 SHERMAN AVE NW UNIT 1
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City | WASHINGTON
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State | DC
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Zip | 20001-3921
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Country | US
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Telephone | 773-816-9877
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401418519
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License Number State | VA
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