Provider Demographics
NPI:1346327905
Name:MADDEN, THERESA E (DDS)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:E
Last Name:MADDEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0220 SW TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2342
Mailing Address - Country:US
Mailing Address - Phone:503-638-0623
Mailing Address - Fax:
Practice Address - Street 1:611 SW CAMPUS DR
Practice Address - Street 2:ROOM 19
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3001
Practice Address - Country:US
Practice Address - Phone:503-494-4316
Practice Address - Fax:503-494-8384
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD68491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics