Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 9422 | NC |
NPI | 1003151630 |
---|---|
Provider Name | Dr. Kristin Madden |
First Address | Sanford, NC 27330-8984 |
Second Address | Sanford, NC 27330-8984 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2012 |
Last Update Date | 08/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9422 | NC DENTAL LICENSE (01) | NC |