Provider Demographics
NPI:1033659750
Name:MADAYAG, VIRGINIA V (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:V
Last Name:MADAYAG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 EL CAMINO REAL
Mailing Address - Street 2:SUITE K
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1309
Mailing Address - Country:US
Mailing Address - Phone:650-875-6808
Mailing Address - Fax:650-741-9799
Practice Address - Street 1:1230 EL CAMINO REAL
Practice Address - Street 2:SUITE K
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-1309
Practice Address - Country:US
Practice Address - Phone:650-875-6808
Practice Address - Fax:650-741-9799
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist