Provider Demographics
NPI:1265561799
Name:MADAMBA, FRANCIS (DDS)
Entity type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:
Last Name:MADAMBA
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 1:3432 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5006
Mailing Address - Country:US
Mailing Address - Phone:618-465-5815
Mailing Address - Fax:618-465-5927
Practice Address - Street 1:3432 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5006
Practice Address - Country:US
Practice Address - Phone:618-465-5815
Practice Address - Fax:618-465-5927
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9181947Medicaid