Provider Demographics
NPI:1336751080
Name:BRINDLE, MADISON LEE (DMD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:LEE
Last Name:BRINDLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-4919
Mailing Address - Country:US
Mailing Address - Phone:802-334-1400
Mailing Address - Fax:
Practice Address - Street 1:494 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-4919
Practice Address - Country:US
Practice Address - Phone:802-334-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0133965EMGY122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist