Basic Information
| Provider Information | |||||||||
| NPI: | 1407884554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADDEN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 DELAWARE ST SE | ||||||||
| Address2: | ROOM 16-116 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554550357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126249696 | ||||||||
| FaxNumber: | 6126260449 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 DELAWARE ST SE | ||||||||
| Address2: | ROOM 16-116 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554550357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126243130 | ||||||||
| FaxNumber: | 6126260449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 01/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | D10328 | MN | Y | Dental Providers | Dentist | General Practice |
No ID Information.