Provider Demographics
NPI:1811554116
Name:NIZIAK, MADELINE LEIGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:LEIGH
Last Name:NIZIAK
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 1:195 BINNEY ST APT 2306
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1048
Mailing Address - Country:US
Mailing Address - Phone:617-759-0044
Mailing Address - Fax:
Practice Address - Street 1:21 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2634
Practice Address - Country:US
Practice Address - Phone:508-422-7190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18582971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice