Basic Information
| Provider Information | |||||||||
| NPI: | 1295841534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADDEN | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8512 SUGAR CREEK DR | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273327571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197744299 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 CARTHAGE ST | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273308984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197744433 | ||||||||
| FaxNumber: | 9197754041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 5031 | NC | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 95445 | 01 | NC | BCBS OF NC | OTHER | 8995445 | 05 | NC | MEDICAID |