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Individual
DR. ETHAN SEAN MADISON
Active
Individual
DR. ETHAN SEAN MADISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
109310
CA
122300000X
Dentist
Primary
D.007218-C1
AL
1223P0300X
Periodontics
109310
CA
1223P0300X
Periodontics
Primary
D.007218-C1
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/31/2023
Last updated
08/11/2026
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