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General NPI Number Information
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NPI Number | 1538454202
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Entity Type | Individual
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Provider Name | WILLIAM P MADISON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 811 W WELLINGTON AVE DEPARTMENT OF DENTISTRY
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City | CHICAGO
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State | IL
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Zip | 60657-5123
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Country | US
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Telephone | 773-871-1461
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Fax |
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Provider Business Mailing Address
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Address Line | 1319 W FILLMORE ST UNIT 3
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City | CHICAGO
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State | IL
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Zip | 60607-4806
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Country | US
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Telephone | 630-803-1322
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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 | 019028626
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License Number State | IL
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