Provider Demographics
NPI:1568984748
Name:SHADIX, MARY-LYNN MADDOX (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY-LYNN
Middle Name:MADDOX
Last Name:SHADIX
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 1:513 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5301
Mailing Address - Country:US
Mailing Address - Phone:256-543-7444
Mailing Address - Fax:
Practice Address - Street 1:513 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5301
Practice Address - Country:US
Practice Address - Phone:256-543-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6434122300000X
FLDN22686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist