Provider Demographics
NPI:1154451789
Name:PETER CHARLES MADDEN DDS INC
Entity Type:Organization
Organization Name:PETER CHARLES MADDEN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-271-6322
Mailing Address - Street 1:6839 WOOSTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-4328
Mailing Address - Country:US
Mailing Address - Phone:513-271-6322
Mailing Address - Fax:513-271-6373
Practice Address - Street 1:6839 WOOSTER PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-4328
Practice Address - Country:US
Practice Address - Phone:513-271-6322
Practice Address - Fax:513-271-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 . 0196831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty