Provider Demographics
NPI:1174982458
Name:MADURO, LEDESHA MARIE DOROTHY (DDS)
Entity type:Individual
Prefix:
First Name:LEDESHA
Middle Name:MARIE DOROTHY
Last Name:MADURO
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 1:67184 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-1914
Mailing Address - Country:US
Mailing Address - Phone:586-727-5898
Mailing Address - Fax:
Practice Address - Street 1:67184 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1914
Practice Address - Country:US
Practice Address - Phone:954-298-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22776122300000X
MI2901602045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist