Individual
DR. LARRY F MADSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
299 JUANA AVE, SUITE E, SAN LEANDRO, CA 94577-4838
(510) 352-2111
Mailing address
299 JUANA AVE, SUITE E, SAN LEANDRO, CA 94577-4838
(510) 352-2111
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
22906
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22906
DENTAL LICENSE NUMBER
CA
Enumeration date
09/24/2007
Last updated
09/24/2007
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