# MADISON PEDIATRIC DENTAL, SC

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

## Provider details

- **NPI number:** 1538230966
- **Authorized official:** JANET WILL (OFFICE MANAGER)
- **Authorized official phone:** (608) 222-6160

## Contact information

- **Practice address:** 100 RIVER PL, SUITE 110, MADISON, WI 53716-4041
- **Practice address phone:** (608) 222-6160
- **Practice address fax:** (608) 222-6248
- **Mailing address:** 100 RIVER PL, SUITE 110, MADISON, WI 53716-4041
- **Mailing address phone:** (608) 222-6160
- **Mailing address fax:** (608) 222-6248

## Taxonomy

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

## Other

- **Enumeration date:** 11/09/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33376600 | — | WI |