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General NPI Number Information
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NPI Number | 1659567972
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Entity Type | Organization
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Legal Business Name | JOSEPH D. MADISON, DMD, LTD.
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/20/2007
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Provider Practice Location Address
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Address Line | 11800 SUNRISE VALLEY DR SUITE 1137
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City | RESTON
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State | VA
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Zip | 20191-5300
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Country | US
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Telephone | 703-391-8836
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Fax | 703-391-6802
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Provider Business Mailing Address
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Address Line | 11800 SUNRISE VALLEY DR SUITE 1137
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City | RESTON
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State | VA
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Zip | 20191-5300
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Country | US
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Telephone | 703-391-8836
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Fax | 703-391-6802
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH DWAYNE MADISON
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Credential | D.M.D.
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Telephone | 703-391-8836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401006578
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License Number State | VA
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