Provider Demographics
NPI:1023191566
Name:MADSEN, DALE WINTERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:WINTERS
Last Name:MADSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 E 1ST AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926
Mailing Address - Country:US
Mailing Address - Phone:530-343-1081
Mailing Address - Fax:530-343-1035
Practice Address - Street 1:1279 E 1ST AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-343-1081
Practice Address - Fax:530-343-1035
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309221223G0001X
CADS30922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice