Provider Demographics
NPI:1194916981
Name:DANIEL C. MADION DDS, MD PLLC
Entity type:Organization
Organization Name:DANIEL C. MADION DDS, MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MADION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:231-922-2100
Mailing Address - Street 1:601 S GARFIELD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-3481
Mailing Address - Country:US
Mailing Address - Phone:231-922-2100
Mailing Address - Fax:
Practice Address - Street 1:601 S GARFIELD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3481
Practice Address - Country:US
Practice Address - Phone:231-922-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010195321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty