Healthcare Provider Details

I. General information

NPI: 1427292515
Provider Name (Legal Business Name): AFFORDABLE DENTURES - EVANSVILLE IV, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N 1ST AVE
EVANSVILLE IN
47710-1217
US

IV. Provider business mailing address

206 N 1ST AVE
EVANSVILLE IN
47710-1217
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 Number12007421A
License Number StateIN

VIII. Authorized Official

Name: CHRISTOPHER NIGH
Title or Position: OWNER
Credential: DDS
Phone: 812-428-3384