Provider Demographics
NPI:1710470810
Name:MADERA, MARIA GUADALUPE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:GUADALUPE
Last Name:MADERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 JAMES DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6027
Mailing Address - Country:US
Mailing Address - Phone:325-330-1187
Mailing Address - Fax:
Practice Address - Street 1:5000 HIGHWAY 114
Practice Address - Street 2:UNIT 130
Practice Address - City:NORTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:940-208-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist