Provider Demographics
NPI:1689954356
Name:MADISON DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:MADISON DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:SHEFTALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:843-991-0344
Mailing Address - Street 1:115 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8224
Mailing Address - Country:US
Mailing Address - Phone:256-837-3274
Mailing Address - Fax:256-837-3696
Practice Address - Street 1:115 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8224
Practice Address - Country:US
Practice Address - Phone:256-837-3274
Practice Address - Fax:256-837-3696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty