Provider Demographics
NPI:1942316773
Name:USO, MADRID (DDS)
Entity Type:Individual
Prefix:
First Name:MADRID
Middle Name:
Last Name:USO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 WASHBURN WAY
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4518
Mailing Address - Country:US
Mailing Address - Phone:541-884-5464
Mailing Address - Fax:541-850-8847
Practice Address - Street 1:2700 WASHBURN WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4518
Practice Address - Country:US
Practice Address - Phone:541-884-5464
Practice Address - Fax:541-850-8847
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD86261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice