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General NPI Number Information
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NPI Number | 1578732962
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Entity Type | Organization
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Legal Business Name | ECONOMY DENTURES
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 2400 S RIDGEWOOD AVE STE 10B
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City | SOUTH DAYTONA
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State | FL
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Zip | 32119-5005
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Country | US
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Telephone | 386-761-9681
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Fax | 386-761-9107
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Provider Business Mailing Address
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Address Line | 2400 SOUTH RIDGEWOOD AVE #10B
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City | SOUTH DAYTONA
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State | FL
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Zip | 32119-3097
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Country | US
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Telephone | 386-761-9681
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Fax | 386-761-9107
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Authorized Official
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Title or Position | D.M.D
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Name | DR. LEROY R. POLITE
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Credential |
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Telephone | 386-761-9681
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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 | DN10854
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License Number State | FL
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