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General NPI Number Information
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NPI Number | 1649727322
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Entity Type | Individual
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Provider Name | ASHLEY MADERN D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 5855 W UTOPIA RD
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City | GLENDALE
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State | AZ
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Zip | 85308-5251
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Country | US
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Telephone | 623-806-7000
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Fax | 623-806-7010
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Provider Business Mailing Address
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Address Line | 1608 W WHITE FEATHER LN
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City | PHOENIX
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State | AZ
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Zip | 85085-5341
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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 | 10496
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number | D011491
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License Number State | AZ
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