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General NPI Number Information
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NPI Number | 1952088270
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Entity Type | Individual
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Provider Name | ZACHARY MADER DDS
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Gender | Male
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 10945 ULYSSES ST NE STE 100
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City | BLAINE
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State | MN
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Zip | 55434-4186
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Country | US
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Telephone | 763-784-1993
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Fax |
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Provider Business Mailing Address
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Address Line | 2565 FRANKLIN AVE APT 311
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City | SAINT PAUL
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State | MN
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Zip | 55114-3003
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Country | US
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Telephone | 52-460-0894
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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 | D15034
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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