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General NPI Number Information
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NPI Number | 1902369994
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Entity Type | Organization
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Legal Business Name | MADISON PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 04/08/2019
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Last Update Date | 04/08/2019
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Provider Practice Location Address
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Address Line | 635 E MARYLAND AVE
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City | PHOENIX
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State | AZ
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Zip | 85012-1133
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Country | US
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Telephone | 602-313-8707
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Fax |
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Provider Business Mailing Address
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Address Line | 635 E MARYLAND AVE
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City | PHOENIX
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State | AZ
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Zip | 85012-1133
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Country | US
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Telephone | 602-313-8707
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RISHI POPAT
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Credential | DMD, DMSC.
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Telephone | 602-697-8149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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