Provider Demographics
NPI:1942768130
Name:DIPAOLO, MADELEINE LEIGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:MADELEINE
Middle Name:LEIGH
Last Name:DIPAOLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:LEIGH
Other - Last Name:DIPAOLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:219 AVENUE I STE 200
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5618
Mailing Address - Country:US
Mailing Address - Phone:775-750-4986
Mailing Address - Fax:
Practice Address - Street 1:219 AVENUE I STE 200
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:310-373-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026050122300000X, 1223P0221X
CA1061211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0392787Medicaid