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General NPI Number Information
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NPI Number | 1356640965
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Entity Type | Individual
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Provider Name | MADELINE REGINA LODUCA D.M.D.P.C
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Gender | Female
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Dates
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Enumeration Date | 03/22/2011
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 3909 210TH ST
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City | BAYSIDE
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State | NY
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Zip | 11361-1977
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Country | US
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Telephone | 718-225-4888
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Fax |
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Provider Business Mailing Address
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Address Line | 653 152ND ST
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City | WHITESTONE
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State | NY
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Zip | 11357-1200
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Country | US
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Telephone | 718-943-0125
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 041265-1
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License Number State | NY
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