MEDICARE: AFFORDABLE DENTURES & IMPLANTS - LAKE MARY, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1356826945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES & IMPLANTS - LAKE MARY, P.A.

Provider Business Mailing Address
First Line	:	890 S SUN DR
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	890 S SUN DR
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2406
Country	:	US
Telephone Number	:	404-333-4610
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	DANIEL FENTON
Credential	:	DMD
Telephone Number	:	404-333-4610

Provider Enumeration Date	:	09/28/2018
Last Update Date	:	10/10/2018

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