MEDICARE: MADRID USO 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	D8626	OR

General Provider Information

NPI Number	:	1942316773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADRID USO DDS

Provider Business Mailing Address
First Line	:	2700 WASHBURN WAY
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4518
Country	:	US
Telephone Number	:	541-884-5464
Fax Number	:	541-850-8847

Provider Business Practice Location Address
First Line	:	2700 WASHBURN WAY
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4518
Country	:	US
Telephone Number	:	541-884-5464
Fax Number	:	541-850-8847

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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