Provider Demographics
NPI:1760552319
Name:MADISON, STEVE A (DMD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:A
Last Name:MADISON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 FORKS OF THE RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3422
Mailing Address - Country:US
Mailing Address - Phone:865-428-2229
Mailing Address - Fax:
Practice Address - Street 1:489 FORKS OF THE RIVER PKWY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3422
Practice Address - Country:US
Practice Address - Phone:865-453-0032
Practice Address - Fax:865-453-3985
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS41221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice