Individual
DR. MADISON FANTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2300 HAGGERTY RD STE 1180, WEST BLOOMFIELD, MI 48323-2188
(248) 787-2037
Mailing address
2300 HAGGERTY RD STE 1180, WEST BLOOMFIELD, MI 48323-2188
(248) 787-2037
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
2901601213
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/05/2021
Last updated
07/13/2022
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