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General NPI Number Information
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NPI Number | 1487897575
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Entity Type | Organization
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Legal Business Name | ECONOMY DENTURES OF HUDSON LLC
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 12123 LITTLE RD
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City | HUDSON
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State | FL
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Zip | 34667-2924
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Country | US
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Telephone | 727-862-5474
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Fax |
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Provider Business Mailing Address
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Address Line | 1680 DUNN AVE SUITE 31
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4782
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Country | US
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Telephone | 904-696-6767
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEROY R POLITE
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Credential | D.M.D
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Telephone | 904-696-6767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN 8243
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License Number State | FL
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