# MADISON PEDIATRIC DENTISTRY LLC

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

## Provider details

- **NPI number:** 1184935959
- **Authorized official:** DR. WESLEY MOFFETT D.M.D. (MEMBER)
- **Authorized official phone:** (205) 792-0003

## Contact information

- **Practice address:** 7559 HIGHWAY 72 W, SUITE C7/C8, MADISON, AL 35758-8811
- **Practice address phone:** (256) 527-4590
- **Practice address fax:** (256) 890-4293
- **Mailing address:** 7559 HIGHWAY 72 W, MADISON, AL 35758-8811
- **Mailing address phone:** (256) 527-4590
- **Mailing address fax:** (256) 890-4293

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 06/27/2010
- **Last updated:** 04/15/2013