MEDICARE: DR. TREVOR JOSEPH MADDEN 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	29974	TX

General Provider Information

NPI Number	:	1558774471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR JOSEPH MADDEN D.D.S.

Provider Business Mailing Address
First Line	:	16560 N. RM 620 RD.
Second Line	:	104
City	:	ROUND ROCK
State	:	TX
Zip	:	78681
Country	:	US
Telephone Number	:	402-617-2707
Fax Number	:

Provider Business Practice Location Address
First Line	:	16560 N. RANCH TO MARKET 620 RD.
Second Line	:	104
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-5799
Country	:	US
Telephone Number	:	402-617-2707
Fax Number	:

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

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	06/09/2014

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Directions to “ DR. TREVOR JOSEPH MADDEN D.D.S.” Practice Location

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