Healthcare Provider Details

I. General information

NPI: 1932342136
Provider Name (Legal Business Name): AFFORDABLE DENTURES - ORLANDO WEST, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 BLACKWOOD AVE
OCOEE FL
34761-4518
US

IV. Provider business mailing address

1163 BLACKWOOD AVE
OCOEE FL
34761-4518
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-3828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 9774
License Number StateFL

VIII. Authorized Official

Name: DAVID M SIMMS
Title or Position: PRACTICE OWNER
Credential: DMD
Phone: 407-877-3828