MEDICARE: SERGE MADHERE D.D.S

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	122300000X	Dentist	052905-1	NY
2	122300000X	Dentist	33602	TX

General Provider Information

NPI Number	:	1073712436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGE MADHERE D.D.S

Provider Business Mailing Address
First Line	:	10177 W GRAND PKWY S STE 103
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-8643
Country	:	US
Telephone Number	:	346-702-3085
Fax Number	:

Provider Business Practice Location Address
First Line	:	10177 W GRAND PKWY S STE 103
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-8643
Country	:	US
Telephone Number	:	346-702-3085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	03/23/2018

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