Healthcare Provider Details

I. General information

NPI: 1306475421
Provider Name (Legal Business Name): ANTHONY EDGAR ACUNA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 E DRAPER PKWY STE G
DRAPER UT
84020-9391
US

IV. Provider business mailing address

308 W NORTH TEMPLE APT 332
SALT LAKE CITY UT
84103-1898
US

V. Phone/Fax

Practice location:
  • Phone: 801-571-9555
  • Fax:
Mailing address:
  • Phone: 407-562-8698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11793599-9922
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: