Provider Demographics
NPI:1134280712
Name:MADDUX, BRETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:MADDUX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 EDWARDS LAKE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3128
Mailing Address - Country:US
Mailing Address - Phone:205-661-1234
Mailing Address - Fax:205-661-0579
Practice Address - Street 1:3240 EDWARDS LAKE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3128
Practice Address - Country:US
Practice Address - Phone:205-661-1234
Practice Address - Fax:205-661-0579
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48031223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics