Provider Demographics
NPI:1942510029
Name:MADDER, BARNEY, DMD, PLLC
Entity Type:Organization
Organization Name:MADDER, BARNEY, DMD, PLLC
Other - Org Name:KENNEWICK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-374-4077
Mailing Address - Street 1:7233 W DESCHUTES AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6707
Mailing Address - Country:US
Mailing Address - Phone:509-374-4077
Mailing Address - Fax:
Practice Address - Street 1:9501 W CLEARWATER AVE
Practice Address - Street 2:STE A120
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-374-4077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000102441223G0001X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty