MEDICARE: DR. PASIL AHMED MADANY DDS

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	019.032758	IL
2	122300000X	Dentist	30.025641	OH

General Provider Information

NPI Number	:	1447715222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PASIL AHMED MADANY DDS

Provider Business Mailing Address
First Line	:	1004 N GILBERT ST
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-3849
Country	:	US
Telephone Number	:	217-442-4267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 N GILBERT ST
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-3849
Country	:	US
Telephone Number	:	217-442-4267
Fax Number	:

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

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	08/25/2020

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Directions to “ DR. PASIL AHMED MADANY DDS” Practice Location

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