Provider Demographics
NPI:1710181938
Name:MADISON, ROBERT I (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:MADISON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W END AVE
Mailing Address - Street 2:PROFESSIONAL SUITE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4848
Mailing Address - Country:US
Mailing Address - Phone:718-743-1339
Mailing Address - Fax:718-332-4891
Practice Address - Street 1:2 W END AVE
Practice Address - Street 2:PROFESSIONAL SUITE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4848
Practice Address - Country:US
Practice Address - Phone:718-743-1339
Practice Address - Fax:718-332-4891
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice