Provider Demographics
NPI:1811696685
Name:DAVID, MADISON LEIGH (RDH, BSDH)
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:LEIGH
Last Name:DAVID
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6860 MOUSE CREEK RD NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-6348
Mailing Address - Country:US
Mailing Address - Phone:423-790-4985
Mailing Address - Fax:
Practice Address - Street 1:414 BERYWOOD TRL NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5251
Practice Address - Country:US
Practice Address - Phone:423-476-6258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10053124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist