Madison Mack, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

32168 Issued in TX

Practice address

3008 H G Mosley Pkwy
Longview, TX 75605-2948

Phone

(903) 236-4050

Fax

(903) 753-4426

NPI assigned

Aug 22, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mack Dental

  • Dental Clinic/Center
  • Longview, TX
  • NPI 1942840004
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471824000000",
    "number": "1164977997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3008 H G MOSLEY PKWY",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052948",
            "telephone_number": "903-236-4050",
            "fax_number": "903-753-4426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3008 H G MOSLEY PKWY",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052948",
            "telephone_number": "903-236-4050",
            "fax_number": "903-753-4426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "MADISON",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-22",
        "last_updated": "2016-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "32168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mack Dental
• Baleigh Paige Mack, DDS
• James Andrew Mack, DDS
• John B Mack, MD
• Kelly Wade Mack, DDS
• Samuel Christopher Mack, D.D.S.
• Shundra Mack
• Simon Lucas Mack, D.D.S.
• Susan M Maddox
• Ugochukwu Ikechi Maduforo, MD

• Dentist in Longview, TX
• Providers in Longview, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.