Provider Demographics
NPI:1326045030
Name:MADISON ENDODONTIC ASSOCIATES S.C
Entity Type:Organization
Organization Name:MADISON ENDODONTIC ASSOCIATES S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-231-9989
Mailing Address - Street 1:406 SCIENCE DR
Mailing Address - Street 2:STE 410
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1068
Mailing Address - Country:US
Mailing Address - Phone:608-231-9989
Mailing Address - Fax:608-231-2814
Practice Address - Street 1:406 SCIENCE DR
Practice Address - Street 2:STE 410
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1068
Practice Address - Country:US
Practice Address - Phone:608-231-9989
Practice Address - Fax:608-231-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty