Active NPI
Larry F Madsen, DDS
- Periodontics
- San Leandro, CA
National Provider Identifier
1689860579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 22906
- Practice address
- 299 Juana Ave
Suite E
San Leandro, CA 94577-4838 - Phone
- (510) 352-2111
- NPI assigned
- Sep 24, 2007
- Last updated
- Sep 24, 2007
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 22906 | CA | Primary |
Addresses
Primary practice location
299 Juana Ave
Suite E
San Leandro, CA 94577-4838
Mailing address
299 Juana Ave
Suite E
San Leandro, CA 94577-4838
Phone (510) 352-2111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22906 | Other | CA | DENTAL LICENSE NUMBER |
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 |
|---|---|---|---|
| 22906 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190592000000",
"number": "1689860579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "299 JUANA AVE",
"address_2": "SUITE E",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945774838",
"telephone_number": "510-352-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "299 JUANA AVE",
"address_2": "SUITE E",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945774838",
"telephone_number": "510-352-2111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADSEN",
"first_name": "LARRY",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-24",
"last_updated": "2007-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "CA",
"license": "22906",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE NUMBER",
"identifier": "22906",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.