Provider Demographics
NPI:1336275825
Name:VIRGINIA V MADAYAG DDS INC
Entity Type:Organization
Organization Name:VIRGINIA V MADAYAG DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MADAYAG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-991-7055
Mailing Address - Street 1:901 CAMPUS DRIVE SUITE 201
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4930
Mailing Address - Country:US
Mailing Address - Phone:650-991-7055
Mailing Address - Fax:650-991-7485
Practice Address - Street 1:901 CAMPUS DRIVE SUITE 201
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4930
Practice Address - Country:US
Practice Address - Phone:650-991-7055
Practice Address - Fax:650-991-7485
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA V MADAYAG DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-26
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty