Healthcare Provider Details

I. General information

NPI: 1295132512
Provider Name (Legal Business Name): AFFORDABLE DENTURES - LAGRANGE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 LAFAYETTE PKWY SUITE E
LAGRANGE GA
30241-2612
US

IV. Provider business mailing address

1300 LAFAYETTE PKWY SUITE E
LAGRANGE GA
30241-2612
US

V. Phone/Fax

Practice location:
  • Phone: 706-882-0322
  • Fax: 706-882-0324
Mailing address:
  • Phone: 706-882-0322
  • Fax: 706-882-0324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN013386
License Number StateGA

VIII. Authorized Official

Name: YASUKO MUSASHI
Title or Position: DDS/PRACTICE OWNER
Credential:
Phone: 706-882-0322