Provider Demographics
NPI:1891837522
Name:MADION, DANIEL (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:MADION
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12776 S WEST BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5451
Mailing Address - Country:US
Mailing Address - Phone:231-946-3512
Mailing Address - Fax:231-946-1908
Practice Address - Street 1:12776 S WEST BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5451
Practice Address - Country:US
Practice Address - Phone:231-946-3512
Practice Address - Fax:231-946-1908
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010195321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery