Provider Demographics
NPI:1609027325
Name:ROBERT E. MADDUX DDS INC.
Entity Type:Organization
Organization Name:ROBERT E. MADDUX DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MADDUX
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:662-429-6736
Mailing Address - Street 1:2264 MCINGVALE ROAD
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632
Mailing Address - Country:US
Mailing Address - Phone:662-429-6736
Mailing Address - Fax:
Practice Address - Street 1:2264 MCINGVALE RD
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-8710
Practice Address - Country:US
Practice Address - Phone:662-429-6736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2705921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty