Provider Demographics
NPI:1831756287
Name:SLAMA, MADELEINE GAMBLE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MADELEINE
Middle Name:GAMBLE
Last Name:SLAMA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 YANKEE DOODLE RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1801
Mailing Address - Country:US
Mailing Address - Phone:651-452-3333
Mailing Address - Fax:
Practice Address - Street 1:1480 YANKEE DOODLE RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1801
Practice Address - Country:US
Practice Address - Phone:651-452-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14204122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist