Organization
MADISON FAMILY DENTISTRY
Active
Other names
Jesse W. Duquette
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESSE WILLIAM DUQUETTE DDS (OWNER)
(812) 273-6744
Entity
Organization
Contact information
Practice address
1739 MICHIGAN RD, MADISON, IN 47250-2721
(812) 273-6744
(812) 265-4025
Mailing address
1739 MICHIGAN RD, MADISON, IN 47250-2721
(812) 273-6744
(812) 265-4025
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12010146A
IN
1223P0221X
Pediatric Dentistry
3853
KY
1223P0221X
Pediatric Dentistry
Primary
8174
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200527470-A
—
IN
01
—
678416
UNITED CONCORDIA
IN
Enumeration date
05/29/2008
Last updated
08/28/2008
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