Ethan Sean Madison, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D.007218-C1 Issued in AL

Practice address

350 S Beverly Dr Ste 160
Beverly Hills, CA 90212-4815

Phone

(310) 553-2940

NPI assigned

May 31, 2023

Last updated

Aug 11, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Ethan Madison, DDS Inc

  • Periodontics
  • Beverly Hills, CA
  • NPI 1285556563
  Authorized official Same address or phone
• Miles Madison D D S Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Beverly Hills, CA
  • NPI 1538662036
  NPD

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

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786406400000",
    "number": "1356034789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 S BEVERLY DR STE 160",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902124815",
            "telephone_number": "310-713-9548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 S BEVERLY DR STE 160",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902124815",
            "telephone_number": "310-553-2940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2732 Santa Anita Ave",
            "address_purpose": "LOCATION",
            "city": "El Monte",
            "state": "CA",
            "postal_code": "917332262",
            "country_code": "US",
            "telephone_number": "626-444-2605",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "44244 Division St",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "CA",
            "postal_code": "935353525",
            "country_code": "US",
            "telephone_number": "310-713-9548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MADISON",
        "first_name": "ETHAN",
        "middle_name": "SEAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-31",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "AL",
            "license": "D.007218-C1",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "109310",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liza Green Golan Mackintosh, M.D.
• Robert Maclennan, CRNA
• Shelly Rebeka Madan
• Kourosh Maddahi, DDS
• Tiffany Maddahi
• Marjan Smith Madison, PSY.D.
• Miles Madison, DDS
• Madkan Dermatology, PC (Mosaic Dermatology)
• Peter Nicholson Maduro, J.D., PSY.D.
• Mafl Medical Inc a Professional Corporation

• Periodontics in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; 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.