Provider Demographics
NPI:1457555732
Name:MADADI, ALEN (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEN
Middle Name:
Last Name:MADADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:MOHAMMOND
Other - Middle Name:
Other - Last Name:MADADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:4955 N SABINO CANYON RD STE 103
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-6491
Mailing Address - Country:US
Mailing Address - Phone:520-299-5122
Mailing Address - Fax:520-232-9015
Practice Address - Street 1:4955 N SABINO CANYON RD STE 103
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-6491
Practice Address - Country:US
Practice Address - Phone:520-299-5122
Practice Address - Fax:520-232-9015
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD53241223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics