Provider Demographics
NPI:1982129474
Name:LA MADRID, DARREN (DDS)
Entity type:Individual
Prefix:DR
First Name:DARREN
Middle Name:
Last Name:LA MADRID
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SECLUSION PT APT E
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7978
Mailing Address - Country:US
Mailing Address - Phone:501-538-6517
Mailing Address - Fax:
Practice Address - Street 1:5198 N NEVADA AVE STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8649
Practice Address - Country:US
Practice Address - Phone:501-538-6517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist