Provider Demographics
NPI:1710400783
Name:MADISON, MARJORIE ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:ELIZABETH
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 1:4347 MILLERS CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-2139
Mailing Address - Country:US
Mailing Address - Phone:803-493-5256
Mailing Address - Fax:
Practice Address - Street 1:2708 PEARLAND PKWY STE 220
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5353
Practice Address - Country:US
Practice Address - Phone:281-949-4609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX378781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice