Provider Demographics
NPI:1720325335
Name:MADISON FAMILY DENTAL, LLC
Entity type:Organization
Organization Name:MADISON FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KSHATRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-581-2233
Mailing Address - Street 1:231 W OLD HICKORY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-3664
Mailing Address - Country:US
Mailing Address - Phone:615-865-5750
Mailing Address - Fax:615-868-8638
Practice Address - Street 1:231 W OLD HICKORY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-3664
Practice Address - Country:US
Practice Address - Phone:615-865-5750
Practice Address - Fax:615-868-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN89711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty