Provider Demographics
NPI:1740328152
Name:MADERA, NANCY (DMD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:MADERA
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 1:931 SAN BRUNO AVE W
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3440
Mailing Address - Country:US
Mailing Address - Phone:650-737-0862
Mailing Address - Fax:650-737-6080
Practice Address - Street 1:931 SAN BRUNO AVE W
Practice Address - Street 2:SUITE 6
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3440
Practice Address - Country:US
Practice Address - Phone:650-737-0862
Practice Address - Fax:650-737-6080
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice