Individual
MAYRA MADALENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
520 N 12TH ST, RICHMOND, VA 23298-5064
(786) 587-5303
Mailing address
5913 LAUREL BED LN UNIT B, RICHMOND, VA 23227-5607
(786) 587-5303
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401417562
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/17/2021
Last updated
07/06/2021
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