=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528637980
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEX MADOV DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2021
-----------------------------------------------------
Last Update Date | 09/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2424 N BLUFF ST
-----------------------------------------------------
City | FULTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65251-2709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-310-4075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2424 N BLUFF ST
-----------------------------------------------------
City | FULTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65251-2709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-642-6904
-----------------------------------------------------
Fax | 573-642-7256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2022040132
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------