Provider Demographics
NPI:1427279975
Name:MADDOX, MICHAEL L (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:MADDOX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 S 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901
Mailing Address - Country:US
Mailing Address - Phone:256-543-7444
Mailing Address - Fax:256-543-1111
Practice Address - Street 1:513 S 3RD STREET
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901
Practice Address - Country:US
Practice Address - Phone:256-543-7444
Practice Address - Fax:256-543-1111
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL90799OtherBCBS
AL94255OtherBCBS