Provider Demographics
NPI:1497870083
Name:MADERAL, MARTHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:MADERAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 COWPEN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014
Mailing Address - Country:US
Mailing Address - Phone:305-827-3926
Mailing Address - Fax:305-827-8109
Practice Address - Street 1:6500 COWPEN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-827-3926
Practice Address - Fax:305-827-8109
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist