Provider Demographics
NPI:1629588066
Name:SAUNDERS, MADISON WALLACE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:WALLACE
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MELBOURNE PARK CIRCLE
Mailing Address - Street 2:APT D
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901
Mailing Address - Country:US
Mailing Address - Phone:336-207-0545
Mailing Address - Fax:
Practice Address - Street 1:277 HYDRAULIC RIDGE RD STE 205
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8127
Practice Address - Country:US
Practice Address - Phone:336-207-0545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014157211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice