Provider Demographics
NPI:1487100012
Name:MADISON, CRISTINA MARTINEZ
Entity type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:MARTINEZ
Last Name:MADISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 S WASHINGTON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22314
Mailing Address - Country:US
Mailing Address - Phone:703-813-8156
Mailing Address - Fax:866-727-1214
Practice Address - Street 1:2954 CARRINGTON RD
Practice Address - Street 2:
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79916
Practice Address - Country:US
Practice Address - Phone:703-813-8156
Practice Address - Fax:866-727-1214
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63355126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant