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General NPI Number Information
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NPI Number | 1801414230
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Entity Type | Individual
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Provider Name | MADISON WEST DDS
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Gender | Female
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 6 CADILLAC DR STE 130
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City | BRENTWOOD
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State | TN
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Zip | 37027-5069
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Country | US
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Telephone | 615-373-5914
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Fax |
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Provider Business Mailing Address
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Address Line | 6 CADILLAC DR STE 130
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City | BRENTWOOD
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State | TN
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Zip | 37027-5069
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11350
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License Number State | TN
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