Provider Demographics
NPI:1891988614
Name:MADISON, JOSEPH D (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
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 1:11800 SUNRISE VALLEY DR
Mailing Address - Street 2:SUITE 1137
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5300
Mailing Address - Country:US
Mailing Address - Phone:703-391-8836
Mailing Address - Fax:703-391-6802
Practice Address - Street 1:11800 SUNRISE VALLEY DR
Practice Address - Street 2:SUITE 1137
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5300
Practice Address - Country:US
Practice Address - Phone:703-391-8836
Practice Address - Fax:703-391-6802
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA65781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice