MEDICARE: AFFORDABLE DENTURES & IMPLANTS - TEXAS, PLLC

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	0021124	TX
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1578767661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES & IMPLANTS - TEXAS, PLLC

Provider Business Mailing Address
First Line	:	6316 AZLE AVE
Second Line	:	SUITE 200
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2442
Country	:	US
Telephone Number	:	817-237-7377
Fax Number	:

Provider Business Practice Location Address
First Line	:	6316 AZLE AVE
Second Line	:	SUITE 200
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2442
Country	:	US
Telephone Number	:	817-237-7377
Fax Number	:

Authorized Official
Title or Position	:	ENROLLMENT SPECIALIST
Name	:	HALEY WOOSTER
Credential	:
Telephone Number	:	712-733-8551

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	11/17/2021

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