MEDICARE: MADISON A DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	37446	CA

General Provider Information

NPI Number	:	1033243498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON A DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2732 SANTA ANITA AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91733-2262
Country	:	US
Telephone Number	:	626-444-2605
Fax Number	:	626-444-0615

Provider Business Practice Location Address
First Line	:	2732 SANTA ANITA AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91733-2262
Country	:	US
Telephone Number	:	626-444-2605
Fax Number	:	626-444-0615

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MILES MADISON
Credential	:	DDS
Telephone Number	:	626-444-2605

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	05/21/2024

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