MEDICARE: MADISON M TALIAFERRO 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	1223G0001X	General Practice Dentistry	2594	AR

General Provider Information

NPI Number	:	1902077050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON M TALIAFERRO D.D.S.

Provider Business Mailing Address
First Line	:	372 CORAL RD
Second Line	:
City	:	MALVERN
State	:	AR
Zip	:	72104-7108
Country	:	US
Telephone Number	:	501-337-9212
Fax Number	:	501-337-0280

Provider Business Practice Location Address
First Line	:	372 CORAL RD
Second Line	:
City	:	MALVERN
State	:	AR
Zip	:	72104-7108
Country	:	US
Telephone Number	:	501-337-9212
Fax Number	:	501-337-0280

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

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/17/2008

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