Provider Demographics
NPI:1114611183
Name:KAUFFMAN, MADISON (DMD)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 CITIZENS LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6391
Mailing Address - Country:US
Mailing Address - Phone:850-225-6408
Mailing Address - Fax:
Practice Address - Street 1:1716 KENILWORTH AVE STE 180
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-6086
Practice Address - Country:US
Practice Address - Phone:704-802-5626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC132081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice