Healthcare Provider Details

I. General information

NPI: 1750073409
Provider Name (Legal Business Name): AFFORDABLE DENTURES & IMPLANTS - BLOOMINGTON V, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W INDUSTRIAL BLVD
BLOOMINGTON IN
47403-5139
US

IV. Provider business mailing address

3800 W INDUSTRIAL BLVD
BLOOMINGTON IN
47403-5139
US

V. Phone/Fax

Practice location:
  • Phone: 812-339-9899
  • Fax:
Mailing address:
  • Phone: 812-339-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SAROSH SHAMSI
Title or Position: PRACTICE OWNER
Credential: DMD
Phone: 812-339-9899