Provider Demographics
NPI:1659567972
Name:JOSEPH D. MADISON, DMD, LTD.
Entity Type:Organization
Organization Name:JOSEPH D. MADISON, DMD, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-391-8836
Mailing Address - Street 1:11800 SUNRISE VALLEY DR
Mailing Address - Street 2:SUITE 1137
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5300
Mailing Address - Country:US
Mailing Address - Phone:703-391-8836
Mailing Address - Fax:703-391-6802
Practice Address - Street 1:11800 SUNRISE VALLEY DR
Practice Address - Street 2:SUITE 1137
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5300
Practice Address - Country:US
Practice Address - Phone:703-391-8836
Practice Address - Fax:703-391-6802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006578261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental