Provider Demographics
NPI:1043586019
Name:DR. THERESA E. MADDEN & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:DR. THERESA E. MADDEN & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:360-459-5900
Mailing Address - Street 1:304 W BAY DR NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4953
Mailing Address - Country:US
Mailing Address - Phone:360-459-5900
Mailing Address - Fax:360-459-8720
Practice Address - Street 1:304 W BAY DR NW
Practice Address - Street 2:SUITE 201
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4953
Practice Address - Country:US
Practice Address - Phone:360-459-5900
Practice Address - Fax:360-459-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00009862261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental