Provider Demographics
NPI:1457767428
Name:MADAN, POOJA (DDS)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:MADAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 WHITE DOVE CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7012
Mailing Address - Country:US
Mailing Address - Phone:562-481-9980
Mailing Address - Fax:
Practice Address - Street 1:4997 N TWIN CITY HWY
Practice Address - Street 2:PORT ARTHUR SMILES
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5845
Practice Address - Country:US
Practice Address - Phone:409-548-0685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist