Provider Demographics
NPI:1295857969
Name:MAEDGEN, ALAN LOUIS (DDS)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:LOUIS
Last Name:MAEDGEN
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 1:3220 GUS THOMASSON RD STE 347
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4051
Mailing Address - Country:US
Mailing Address - Phone:972-698-6685
Mailing Address - Fax:
Practice Address - Street 1:3220 GUS THOMASSON RD STE 347
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4051
Practice Address - Country:US
Practice Address - Phone:972-698-6685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX155791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice