Provider Demographics
NPI:1992920920
Name:MADDEN, STEPHEN A (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:MADDEN
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 1:125 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:RANSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:17866-4121
Mailing Address - Country:US
Mailing Address - Phone:570-648-9741
Mailing Address - Fax:
Practice Address - Street 1:618 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-5304
Practice Address - Country:US
Practice Address - Phone:570-644-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-023520-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice