Provider Demographics
NPI:1942435656
Name:TAKALE, MADHURI S (DDS)
Entity Type:Individual
Prefix:
First Name:MADHURI
Middle Name:S
Last Name:TAKALE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MADHURI
Other - Middle Name:S
Other - Last Name:TAKALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 SONATA ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-7021
Mailing Address - Country:US
Mailing Address - Phone:978-608-4005
Mailing Address - Fax:
Practice Address - Street 1:301 SONOMA AISLE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3919
Practice Address - Country:US
Practice Address - Phone:978-608-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2016-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58266122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist