Provider Demographics
NPI:1568585701
Name:MADORSKY, MARK DAVID (DR OF DENTAL SURGERY)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:MADORSKY
Suffix:
Gender:M
Credentials:DR OF DENTAL SURGERY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3910
Mailing Address - Country:US
Mailing Address - Phone:248-642-8130
Mailing Address - Fax:248-642-9314
Practice Address - Street 1:50 W BIG BEAVER RD
Practice Address - Street 2:SUITE 290
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3910
Practice Address - Country:US
Practice Address - Phone:248-642-8130
Practice Address - Fax:248-642-9314
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010107001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice