Provider Demographics
NPI:1538173919
Name:MADISON, CAROLYN A (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:A
Last Name:MADISON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 HAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01950-1612
Mailing Address - Country:US
Mailing Address - Phone:978-462-1881
Mailing Address - Fax:978-463-3596
Practice Address - Street 1:3 CHERRY ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3973
Practice Address - Country:US
Practice Address - Phone:978-463-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice