MEDICARE: AFFORDABLE DENTURES - AVON PARK, 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	:	1538463369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES - AVON PARK, P.A.

Provider Business Mailing Address
First Line	:	1036 US 27 S
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-5114
Country	:	US
Telephone Number	:	863-784-0463
Fax Number	:	863-784-1465

Provider Business Practice Location Address
First Line	:	1036 US 27 S
Second Line	:
City	:	AVON PARK
State	:	FL
Zip	:	33825-5114
Country	:	US
Telephone Number	:	863-784-0463
Fax Number	:	863-784-1465

Authorized Official
Title or Position	:	OWNER
Name	:	MARC SANDER
Credential	:	DDS
Telephone Number	:	863-784-0463

Provider Enumeration Date	:	01/09/2011
Last Update Date	:	01/09/2011

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