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MADISON MODERN DENTISTRY, INC
NPI 1992592406
Dentist - General Practice in Fair Oaks, CA

Active since April 21, 2025CLIA 05D2344032 · Waiver
5315 SUNRISE BLVD, FAIR OAKS, CA 95628(916) 514-5575 Get Directions Write a Review

NPPES record last updated: April 21, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Madison Modern Dentistry, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MADISON MODERN DENTISTRY, INC (NPI 1992592406) is a healthcare organization registered as a general practice in Fair Oaks, California and active in the NPI registry since April 2025. The organization holds a CLIA Waiver certificate valid through May 14, 2028 and lists Colleen Conlon, Owner, as its authorized official.

NPPES Registry Identity

NPI1992592406
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameMADISON MODERN DENTISTRY, INC
Location Address5315 SUNRISE BLVDFair Oaks, CA 95628-3539
Mailing AddressPo Box 660041Dallas, TX 75266-0041
Phone(916) 514-5575
Organization SubpartNo
Authorized OfficialColleen ConlonOwner · (714) 845-8500
Enumeration DateApril 21, 2025
NPPES CertifiedApril 21, 2025
✔ NPI 1992592406 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
5315 SUNRISE BLVD, Fair Oaks, CA 95628
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2344032

Madison Modern Dentistry · Fair Oaks, CA
Active · expires May 14, 2028
CLIA Number05D2344032
Laboratory TypePractitioner Other
Certificate Effective DateMay 15, 2026
Certificate Expiration DateMay 14, 2028
Laboratory DirectorDeepika Dasari
Laboratory Phone(916) 530-2484
Laboratory LocationMadison Modern Dentistry5315 Sunrise Blvd, Fair Oaks, CA 95628
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. VICTOR JOSE MARRUFO
Dentist (General Practice)
5315 SUNRISE BLVD
FAIR OAKS, CA 95628
Sacramento County (191) 653-0248

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Madison Modern Dentistry, Inc's NPI number?

The NPI number for Madison Modern Dentistry, Inc is 1992592406. It was assigned to this organization in the NPPES registry on April 21, 2025.

Where is Madison Modern Dentistry, Inc located?

Madison Modern Dentistry, Inc is located at 5315 Sunrise Blvd, Fair Oaks, CA 95628. The listed phone number is (916) 514-5575.

What is Madison Modern Dentistry, Inc's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Does Madison Modern Dentistry, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2344032) is associated with this NPI, valid through May 14, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Madison Modern Dentistry, Inc was last updated on April 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.