Provider Demographics
NPI:1356640965
Name:LODUCA, MADELINE REGINA (DMDPC)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:REGINA
Last Name:LODUCA
Suffix:
Gender:F
Credentials:DMDPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 152ND ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1200
Mailing Address - Country:US
Mailing Address - Phone:718-943-0125
Mailing Address - Fax:
Practice Address - Street 1:3909 210TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1977
Practice Address - Country:US
Practice Address - Phone:718-225-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041265-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice