Provider Demographics
NPI:1184930059
Name:MADISON FAMILY DENTAL
Entity type:Organization
Organization Name:MADISON FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-256-2670
Mailing Address - Street 1:502 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-2348
Mailing Address - Country:US
Mailing Address - Phone:605-256-2670
Mailing Address - Fax:605-256-3172
Practice Address - Street 1:502 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-2348
Practice Address - Country:US
Practice Address - Phone:605-256-2670
Practice Address - Fax:605-256-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM953261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental