Provider Demographics
NPI:1952370322
Name:NAIR, MADHU K (DMD MS PHD)
Entity Type:Individual
Prefix:DR
First Name:MADHU
Middle Name:K
Last Name:NAIR
Suffix:
Gender:M
Credentials:DMD MS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-5202
Mailing Address - Country:US
Mailing Address - Phone:682-325-9558
Mailing Address - Fax:440-575-0289
Practice Address - Street 1:2600 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-5202
Practice Address - Country:US
Practice Address - Phone:682-325-9558
Practice Address - Fax:440-575-0289
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2018-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTP438204E00000X, 1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076005600Medicaid
66762ZMedicare PIN