Provider Demographics
NPI:1558774471
Name:MADDEN, TREVOR JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:JOSEPH
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 1:16560 N. RM 620 RD.
Mailing Address - Street 2:104
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681
Mailing Address - Country:US
Mailing Address - Phone:402-617-2707
Mailing Address - Fax:
Practice Address - Street 1:16560 N. RANCH TO MARKET 620 RD.
Practice Address - Street 2:104
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-5799
Practice Address - Country:US
Practice Address - Phone:402-617-2707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist