Provider Demographics
NPI:1235264367
Name:BRETT D MADERE DDS APC
Entity Type:Organization
Organization Name:BRETT D MADERE DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MADERE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-536-3193
Mailing Address - Street 1:190 CENTRAL AVENUE RESERVE LA
Mailing Address - Street 2:PO DRAWER O RESERVE LA
Mailing Address - City:RESERVE
Mailing Address - State:LA
Mailing Address - Zip Code:70084
Mailing Address - Country:US
Mailing Address - Phone:985-536-3193
Mailing Address - Fax:
Practice Address - Street 1:190 CENTRAL AVENUE RESERVE LA
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084
Practice Address - Country:US
Practice Address - Phone:985-536-3193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA 4435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty