Provider Demographics
NPI:1730575994
Name:MADISON ORTHODONTICS, PLLC
Entity type:Organization
Organization Name:MADISON ORTHODONTICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RISHI
Authorized Official - Middle Name:
Authorized Official - Last Name:POPAT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, DMSC
Authorized Official - Phone:602-265-0303
Mailing Address - Street 1:635 E MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1133
Mailing Address - Country:US
Mailing Address - Phone:602-265-0303
Mailing Address - Fax:602-783-1365
Practice Address - Street 1:635 E MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1133
Practice Address - Country:US
Practice Address - Phone:602-265-0303
Practice Address - Fax:602-783-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty