Provider Demographics
NPI:1225123193
Name:MADDY, DAVID MORGAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MORGAN
Last Name:MADDY
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 1:507 50TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3845
Mailing Address - Country:US
Mailing Address - Phone:941-792-7777
Mailing Address - Fax:
Practice Address - Street 1:507 50TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3845
Practice Address - Country:US
Practice Address - Phone:941-792-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL 89081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice