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General NPI Number Information
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NPI Number | 1104226315
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURES-EVANSVILLE V, P.C.
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 11/18/2015
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Provider Practice Location Address
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Address Line | 619 N BURKHARDT RD SUITE A
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City | EVANSVILLE
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State | IN
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Zip | 47715-7296
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Country | US
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Telephone | 812-475-2880
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Fax | 812-475-3002
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Provider Business Mailing Address
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Address Line | 619 N BURKHARDT RD SUITE A
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City | EVANSVILLE
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State | IN
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Zip | 47715-7296
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Country | US
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Telephone | 812-475-2880
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Fax | 812-475-3002
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. MICHAEL LEE SKIRVIN
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Credential | DDS
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Telephone | 812-475-2880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12011768A
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License Number State | IN
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