Provider Demographics
NPI:1346445541
Name:MADISON, HUEY PIERCE II (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUEY
Middle Name:PIERCE
Last Name:MADISON
Suffix:II
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 1:3515 DIMOND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2210
Mailing Address - Country:US
Mailing Address - Phone:415-467-1403
Mailing Address - Fax:415-467-0180
Practice Address - Street 1:3515 DIMOND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-2210
Practice Address - Country:US
Practice Address - Phone:415-467-1403
Practice Address - Fax:415-467-0180
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45728122300000X
IL019024779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA522366687OtherEIN