Provider Demographics
NPI:1295868867
Name:MADEK, MARK ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:MADEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 W COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3923
Mailing Address - Country:US
Mailing Address - Phone:248-363-3446
Mailing Address - Fax:248-363-5890
Practice Address - Street 1:522 W COMMERCE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-3923
Practice Address - Country:US
Practice Address - Phone:248-363-3446
Practice Address - Fax:248-363-5890
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI015281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist