Provider Demographics
NPI:1508065590
Name:DAVIDSON, MADALYN M (DMD)
Entity Type:Individual
Prefix:DR
First Name:MADALYN
Middle Name:M
Last Name:DAVIDSON
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 1:30 E 40TH ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-684-6520
Mailing Address - Fax:212-684-6479
Practice Address - Street 1:30 E 40TH ST
Practice Address - Street 2:SUITE 502
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-684-6520
Practice Address - Fax:212-684-6479
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060043-1122300000X
IL019.027395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist