Provider Demographics
NPI:1376790543
Name:MADSON, ANDREW QUENTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:QUENTIN
Last Name:MADSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 COUNTY ROAD D W STE 12
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3517
Mailing Address - Country:US
Mailing Address - Phone:612-788-9246
Mailing Address - Fax:
Practice Address - Street 1:6600 FRANCE AVE S STE 280
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1812
Practice Address - Country:US
Practice Address - Phone:952-236-5686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND125471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery