Provider Demographics
NPI:1528224565
Name:DR. STEVE MADISON & ASSOCIATES
Entity Type:Organization
Organization Name:DR. STEVE MADISON & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:865-453-0032
Mailing Address - Street 1:PO BOX 4625
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37864
Mailing Address - Country:US
Mailing Address - Phone:865-453-0032
Mailing Address - Fax:865-453-3985
Practice Address - Street 1:489 FORKS OF THE RIVER PKWY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3422
Practice Address - Country:US
Practice Address - Phone:865-453-0032
Practice Address - Fax:865-453-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS41221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1356411805OtherNPI