Provider Demographics
NPI:1346807104
Name:HOERZ, MADALYN JO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MADALYN
Middle Name:JO
Last Name:HOERZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7348
Mailing Address - Country:US
Mailing Address - Phone:978-372-0600
Mailing Address - Fax:
Practice Address - Street 1:323 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-7348
Practice Address - Country:US
Practice Address - Phone:978-372-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18583261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice