Provider Demographics
NPI:1871631580
Name:MADDER, DAVID T (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:MADDER
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 1:4250 E MAPLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-4909
Mailing Address - Country:US
Mailing Address - Phone:480-279-1836
Mailing Address - Fax:
Practice Address - Street 1:1757 E BASELINE RD STE 129
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1534
Practice Address - Country:US
Practice Address - Phone:480-545-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist