Provider Demographics
NPI:1760178271
Name:ACKEL, MADISON CLAIRE (DDS)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:CLAIRE
Last Name:ACKEL
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 1:186 SHAMARD DR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6456
Mailing Address - Country:US
Mailing Address - Phone:318-652-3390
Mailing Address - Fax:
Practice Address - Street 1:107 S MORGAN AVE
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4540
Practice Address - Country:US
Practice Address - Phone:337-837-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program