Provider Demographics
NPI:1073712436
Name:MADHERE, SERGE (DDS)
Entity Type:Individual
Prefix:
First Name:SERGE
Middle Name:
Last Name:MADHERE
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 1:10177 W GRAND PKWY S STE 103
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8643
Mailing Address - Country:US
Mailing Address - Phone:346-702-3085
Mailing Address - Fax:
Practice Address - Street 1:10177 W GRAND PKWY S STE 103
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-8643
Practice Address - Country:US
Practice Address - Phone:346-702-3085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052905-1122300000X
TX33602122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist