Provider Demographics
NPI:1174635726
Name:MADDEN, GERARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:
Last Name:MADDEN
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 1:4501 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-3710
Mailing Address - Country:US
Mailing Address - Phone:202-363-3103
Mailing Address - Fax:202-363-3104
Practice Address - Street 1:4501 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 208
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-3710
Practice Address - Country:US
Practice Address - Phone:202-363-3103
Practice Address - Fax:202-363-3104
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC48631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice