MEDICARE: MADELEINE TAWADROS 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
1	122300000X	Dentist	DDS111251	CA
2	122300000X	Dentist	30.026887	OH

General Provider Information

NPI Number	:	1386376697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELEINE TAWADROS DMD

Provider Business Mailing Address
First Line	:	9166 SAN JUAN PL
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-5644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8031 LINDA VISTA RD STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5110
Country	:	US
Telephone Number	:	844-632-6631
Fax Number	:

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

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	12/08/2025

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