Provider Demographics
NPI:1487640801
Name:MADDOX, JOHN ALTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALTON
Last Name:MADDOX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8076B SPRING RUN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3854
Mailing Address - Country:US
Mailing Address - Phone:251-990-8181
Mailing Address - Fax:251-990-8181
Practice Address - Street 1:8076B SPRING RUN RD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3854
Practice Address - Country:US
Practice Address - Phone:251-990-8181
Practice Address - Fax:251-990-8181
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALWEB1MADXOtherSOUTHLAND
ALWEB1MADXOtherWAUSAU
ALJOHNANDNATALIE03OtherMETLIFE
ALWEB1MADXOtherAETNA
AL51511632OtherBLUE CROSS BLUE SHIELD
ALMADDOX99OtherDELTA DENTAL
ALWEB1MADXOtherUNITED CANCORDIA