Provider Demographics
NPI:1366069866
Name:CASE, MADISON NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:NICOLE
Last Name:CASE
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 1:2700 UNIVERSITY AVE W APT 407
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2026
Mailing Address - Country:US
Mailing Address - Phone:612-963-1999
Mailing Address - Fax:
Practice Address - Street 1:18223 CARSON CT NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2733
Practice Address - Country:US
Practice Address - Phone:763-441-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND143941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice