MEDICARE: MADISON WRIGHT-PIEKARSKI 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	1223G0001X	General Practice Dentistry	30.025404	OH

General Provider Information

NPI Number	:	1649769506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON WRIGHT-PIEKARSKI DDS

Provider Business Mailing Address
First Line	:	3927 COLUMBUS RD
Second Line	:
City	:	CENTERBURG
State	:	OH
Zip	:	43011-9475
Country	:	US
Telephone Number	:	740-480-8162
Fax Number	:

Provider Business Practice Location Address
First Line	:	3927 COLUMBUS RD
Second Line	:
City	:	CENTERBURG
State	:	OH
Zip	:	43011-9475
Country	:	US
Telephone Number	:	740-480-8162
Fax Number	:

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

Provider Enumeration Date	:	05/07/2018
Last Update Date	:	05/07/2018

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