Active NPI
Mark Glenn Maddox, DDS
- Dentist
- Tuolumne, CA
National Provider Identifier
1679732432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 23849D
- Practice address
- 18400 Chestnut St
Tuolumne, CA 95379 - Phone
- (209) 928-4262
- NPI assigned
- Jun 6, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 23849D | CA | Primary |
Addresses
Primary practice location
18400 Chestnut St
Tuolumne, CA 95379
Mailing address
PO Box 897
Tuolumne, CA 95379
Phone (209) 928-4262
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23849D | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212710400000",
"number": "1679732432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 897",
"city": "TUOLUMNE",
"state": "CA",
"postal_code": "95379",
"telephone_number": "209-928-4262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18400 CHESTNUT ST",
"city": "TUOLUMNE",
"state": "CA",
"postal_code": "95379",
"telephone_number": "209-928-4262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDOX",
"first_name": "MARK",
"middle_name": "GLENN",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-06",
"last_updated": "2008-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "23849D",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tuolumne, CA
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- Lawrence Eugene Horton, RPH
- Gary Robert Lancaster, PSY
- Gloria Lee Lochridge, FNP
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- Margaret Mary Panella-Spangler, RPH, MS, RD
- Kenneth Keeney Renwick, Jr., MD, MPH, FAAFP
- Nicole Michelle Rincon, PA-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.