Provider Demographics
NPI:1619133345
Name:MADISON, YOLANDA ANN (DMD)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:ANN
Last Name:MADISON
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 1:5151 MOCHEL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5076
Mailing Address - Country:US
Mailing Address - Phone:630-530-4710
Mailing Address - Fax:630-530-4724
Practice Address - Street 1:5151 MOCHEL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5076
Practice Address - Country:US
Practice Address - Phone:630-530-4710
Practice Address - Fax:630-530-4724
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist