Healthcare Provider Details

I. General information

NPI: 1336288083
Provider Name (Legal Business Name): AFFORDABLE DENTURES - BLOOMINGTON, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 INDUSTRIAL BLVD
BLOOMINGTON IN
47403-5139
US

IV. Provider business mailing address

3800 INDUSTRIAL BLVD
BLOOMINGTON IN
47403-5139
US

V. Phone/Fax

Practice location:
  • Phone: 812-428-3384
  • Fax:
Mailing address:
  • Phone: 812-428-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12010316B
License Number StateIN

VIII. Authorized Official

Name: DR. JEFFREY DAVID ADAMS
Title or Position: OWNER
Credential: DMD
Phone: 812-339-9899