Provider Demographics
NPI:1386146512
Name:DUPLESSIS, MADALYN SUZANNE (DMD)
Entity type:Individual
Prefix:MS
First Name:MADALYN
Middle Name:SUZANNE
Last Name:DUPLESSIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2442 MOUNDS VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1478
Mailing Address - Country:US
Mailing Address - Phone:763-316-5400
Mailing Address - Fax:
Practice Address - Street 1:2442 MOUNDS VIEW BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-1478
Practice Address - Country:US
Practice Address - Phone:763-316-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-04
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MND141431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program