Provider Demographics
NPI:1790783108
Name:MADDEN, PHILIP W (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:W
Last Name:MADDEN
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 1:3110 COMMERCIAL AVE
Mailing Address - Street 2:STE 106
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2762
Mailing Address - Country:US
Mailing Address - Phone:360-293-3931
Mailing Address - Fax:360-293-2425
Practice Address - Street 1:3110 COMMERCIAL AVE
Practice Address - Street 2:STE 106
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2762
Practice Address - Country:US
Practice Address - Phone:360-293-3931
Practice Address - Fax:360-293-2425
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist