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General NPI Number Information
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NPI Number | 1689841884
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Entity Type | Individual
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Provider Name | JOHN MADDEN DMD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 1 KNEELAND ST TUSDM PROSTHODONTICS & OPERATIVE DENTISTRY DEPARTMENT
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City | BOSTON
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State | MA
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Zip | 02111-0000
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Country | US
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Telephone | 617-636-2914
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Fax |
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Provider Business Mailing Address
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Address Line | 136 SUDBURY ROAD CONCORD CENTER DENTAL LLC
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City | CONCORD
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State | MA
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Zip | 01742
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Country | US
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Telephone | 978-369-5700
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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 | DN1857208
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License Number State | MA
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