Provider Demographics
NPI:1902369994
Name:MADISON PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:MADISON PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RISHI
Authorized Official - Middle Name:
Authorized Official - Last Name:POPAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, DMSC
Authorized Official - Phone:602-697-8149
Mailing Address - Street 1:635 E MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1133
Mailing Address - Country:US
Mailing Address - Phone:602-313-8707
Mailing Address - Fax:
Practice Address - Street 1:635 E MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1133
Practice Address - Country:US
Practice Address - Phone:602-313-8707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty