Provider Demographics
NPI:1861552564
Name:MADONIAN, MARGARET CAMERON (DDS)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:CAMERON
Last Name:MADONIAN
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 1:600 OSWEGO ST
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5178
Mailing Address - Country:US
Mailing Address - Phone:315-453-2200
Mailing Address - Fax:315-453-2451
Practice Address - Street 1:600 OSWEGO ST
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5178
Practice Address - Country:US
Practice Address - Phone:315-453-2200
Practice Address - Fax:315-453-2451
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0451981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01484702Medicaid