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General NPI Number Information
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NPI Number | 1467013060
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Entity Type | Individual
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Provider Name | CRAIG JOSEPH MADISON DMD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 625 CHERRY TREE LN
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City | UNIONTOWN
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State | PA
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Zip | 15401-8419
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Country | US
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Telephone | 724-437-2121
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Fax |
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Provider Business Mailing Address
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Address Line | 1206 CRATER LAKE LN
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City | COLUMBUS
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State | OH
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Zip | 43085-1504
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Country | US
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Telephone | 412-551-2831
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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 | RES.004145
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS043824
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License Number State | PA
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