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General NPI Number Information
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NPI Number | 1710400783
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Entity Type | Individual
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Provider Name | MARJORIE ELIZABETH MADISON DMD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2017
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 2708 PEARLAND PKWY STE 220
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City | PEARLAND
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State | TX
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Zip | 77581-5353
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Country | US
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Telephone | 281-949-4609
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Fax |
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Provider Business Mailing Address
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Address Line | 4347 MILLERS CREEK LN
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City | MANVEL
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State | TX
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Zip | 77578-2139
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Country | US
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Telephone | 803-493-5256
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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 | 37878
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License Number State | TX
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