Provider Demographics
NPI:1356036198
Name:MOORE, MADISON (DMD)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 SHERMAN AVE NW UNIT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3921
Mailing Address - Country:US
Mailing Address - Phone:773-816-9877
Mailing Address - Fax:
Practice Address - Street 1:4600 JOHN MARR DR STE 401
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3310
Practice Address - Country:US
Practice Address - Phone:703-750-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014185191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics