Provider Demographics
NPI:1265582241
Name:MADDER, NATHAN PHILLIP (DMD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:PHILLIP
Last Name:MADDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 SWIFT BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3560
Mailing Address - Country:US
Mailing Address - Phone:509-943-9300
Mailing Address - Fax:509-943-6030
Practice Address - Street 1:660 SWIFT BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3560
Practice Address - Country:US
Practice Address - Phone:509-943-9300
Practice Address - Fax:509-943-6030
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010244122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist