MEDICARE: MADISON CLAUDEL DDS, LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1235930520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADISON CLAUDEL DDS, LLC

Provider Business Mailing Address
First Line	:	4003 LOUISIANA AVE
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-4634
Country	:	US
Telephone Number	:	377-477-8360
Fax Number	:

Provider Business Practice Location Address
First Line	:	4003 LOUISIANA AVE
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-4634
Country	:	US
Telephone Number	:	337-477-8360
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	MADISON CLAUDEL
Credential	:	DDS
Telephone Number	:	337-477-8360

Provider Enumeration Date	:	03/21/2025
Last Update Date	:	04/08/2025

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