Provider Demographics
NPI:1841030525
Name:DAVIS, MADISON MARIELENA (DDS)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:MARIELENA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 N APACHE RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5802
Mailing Address - Country:US
Mailing Address - Phone:505-414-2198
Mailing Address - Fax:
Practice Address - Street 1:119 W CROSSROADS BLVD STE E
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-5563
Practice Address - Country:US
Practice Address - Phone:385-462-6346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14194109-99261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice