Provider Demographics
NPI:1417686361
Name:ACUNA, MADISON VICTORIA (DMD)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:VICTORIA
Last Name:ACUNA
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 TATE BLVD SE STE 178
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4042
Mailing Address - Country:US
Mailing Address - Phone:828-322-4258
Mailing Address - Fax:828-322-8313
Practice Address - Street 1:915 TATE BLVD SE STE 178
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4042
Practice Address - Country:US
Practice Address - Phone:828-322-4258
Practice Address - Fax:828-322-8313
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT128742501223G0001X
NC140691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice