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General NPI Number Information
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NPI Number | 1386376697
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Entity Type | Individual
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Provider Name | MADELEINE TAWADROS DMD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2022
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 8031 LINDA VISTA RD STE 200
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City | SAN DIEGO
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State | CA
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Zip | 92111-5110
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Country | US
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Telephone | 844-632-6631
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Fax |
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Provider Business Mailing Address
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Address Line | 9166 SAN JUAN PL
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City | LA MESA
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State | CA
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Zip | 91941-5644
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS111251
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.026887
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License Number State | OH
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