Provider Demographics
NPI:1174364764
Name:MADSEN, JOEL MARSHALL (DMD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MARSHALL
Last Name:MADSEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:MN
Mailing Address - Zip Code:56065-9751
Mailing Address - Country:US
Mailing Address - Phone:952-456-2531
Mailing Address - Fax:
Practice Address - Street 1:102 MAIN ST E
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:MN
Practice Address - Zip Code:56065-2058
Practice Address - Country:US
Practice Address - Phone:507-524-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND150951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice