Jeffrey S Mader, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12009190 Issued in IN

Practice address

17490 State Road 23
South Bend, IN 46635-1743

Phone

(574) 271-9000

Fax

(574) 273-1624

NPI assigned

Oct 17, 2006

Sex

Male

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.

• Jeffrey S. Mader, DDS, LLC

  • Dentist
  • South Bend, IN
  • NPI 1841627783
  NPD (past) Authorized official

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851471510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17490 STATE ROAD 23",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351743",
            "telephone_number": "574-271-9000",
            "fax_number": "574-273-1624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17490 STATE ROAD 23",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466351743",
            "telephone_number": "574-271-9000",
            "fax_number": "574-273-1624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADER",
        "first_name": "JEFFREY",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12009190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dauvanique Shion Mackey, RBT
• Sarah Mackin
• Maria Macri
• Rehema Madamu
• Kara Marie Madaras, P.T.A.
• Madison Center, Inc.
• Madison Center, Inc.
• Madison Center, Inc.
• Madison Center, Inc.
• Madison Center, Inc.

• General Practice Dentistry in South Bend, IN
• Providers in South Bend, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.