Individual
DR. JACQUELINE MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1125 SMITHTOWN AVE, BOHEMIA, NY 11716-2160
(631) 589-8585
Mailing address
11 43RD ST, CENTEREACH, NY 11720-2326
(631) 245-4107
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
057987
NY
Other
Enumeration date
04/24/2014
Last updated
08/30/2021
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