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General NPI Number Information
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NPI Number | 1528953486
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Entity Type | Individual
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Provider Name | MADISON GRACE TAPIA DDS
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Gender | Female
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1630 MARKET CENTER BLVD STE 101
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City | O FALLON
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State | MO
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Zip | 63368-8407
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Country | US
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Telephone | 636-734-7563
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Fax |
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Provider Business Mailing Address
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Address Line | 123 AVONDALE MEADOWS DR
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City | WENTZVILLE
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State | MO
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Zip | 63385-6629
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Country | US
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Telephone | 636-328-1186
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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 | 2025019100
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License Number State | MO
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