# MADISON DENTAL DRE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063263028
- **Authorized official:** ELIZABETH DAVIS (DIRECTOR OF REVENUE)
- **Authorized official phone:** (859) 533-1109

## Contact information

- **Practice address:** 308 HIGHLAND PARK DR STE 8174, RICHMOND, KY 40475-3487
- **Practice address phone:** (859) 626-9851
- **Mailing address:** 105 SPRUCE ST, LEXINGTON, KY 40507-2109

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 03/28/2024
- **Last updated:** 03/28/2024