Provider Demographics
NPI:1407884554
Name:MADDEN, RICHARD PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PATRICK
Last Name:MADDEN
Suffix:
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 1:515 DELAWARE ST SE
Mailing Address - Street 2:ROOM 16-116
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0357
Mailing Address - Country:US
Mailing Address - Phone:612-624-9696
Mailing Address - Fax:612-626-0449
Practice Address - Street 1:515 DELAWARE ST SE
Practice Address - Street 2:ROOM 16-116
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0357
Practice Address - Country:US
Practice Address - Phone:612-624-3130
Practice Address - Fax:612-626-0449
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND103281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice