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General NPI Number Information
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NPI Number | 1508995036
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Entity Type | Organization
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Legal Business Name | AFFORDABLE DENTURES -JACKSONVILLE, P.C.
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10503 SAN JOSE BLVD SUITE 10
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City | JACKSONVILLE
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State | FL
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Zip | 32257-6295
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Country | US
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Telephone | 904-262-3695
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Fax |
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Provider Business Mailing Address
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Address Line | 10503 SAN JOSE BLVD SUITE 10
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City | JACKSONVILLE
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State | FL
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Zip | 32257-6295
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Country | US
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Telephone | 904-262-3695
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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. ADRIAN A ATTKISSON
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Credential | DMD
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Telephone | 904-262-3695
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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 | DN16271
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License Number State | FL
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