Samuel Madden

NPI #1164220075 in Travis Afb, California

Provider Information

NPI Number: 1164220075
Entity Type: Individual
Name: Samuel Madden
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Student in an Organized Health Care Education/Training Program
Enumeration Date: Mar 5, 2025
Last Updated: Jul 26, 2025

Practice Location

Address: 101 BODIN CIR BLDG 777
City: Travis Afb
State: California
ZIP Code: 94535-1809
Phone: (612) 619-5261

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X
Student in an Organized Health Care Education/Training Program	390200000X	Primary

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