Provider Demographics
NPI:1336400852
Name:MADONNA, MARIA D (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:D
Last Name:MADONNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:DE PAOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:176 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1115
Mailing Address - Country:US
Mailing Address - Phone:973-321-1277
Mailing Address - Fax:
Practice Address - Street 1:176 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1115
Practice Address - Country:US
Practice Address - Phone:973-321-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021487001223D0001X
NY0397561223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health