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NPI Code Detail

MEDICARE: MS. MADALYN SUZANNE DUPLESSIS DMD

MEDICARE: MS. MADALYN SUZANNE DUPLESSIS DMD
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
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice DentistryD14143MN

General Provider Information

NPI Number : 1386146512
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MADALYN SUZANNE DUPLESSIS DMD
Provider Business Mailing Address
First Line : 2442 MOUNDS VIEW BLVD
Second Line :
City : SAINT PAUL
State : MN
Zip : 55112-1478
Country : US
Telephone Number : 763-316-5400
Fax Number :
Provider Business Practice Location Address
First Line : 2442 MOUNDS VIEW BLVD
Second Line :
City : SAINT PAUL
State : MN
Zip : 55112-1478
Country : US
Telephone Number : 763-316-5400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2018
Last Update Date : 06/03/2021

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