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NPI Code Detail

MEDICARE: AFFORDABLE DENTURES-JACKSONVILLE, P.A.

MEDICARE: AFFORDABLE DENTURES-JACKSONVILLE, 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
1122300000XDentistDN12562FL

General Provider Information

NPI Number : 1982017471
Entity Type Code : Organization
Provider Name (Legal Business Name) : AFFORDABLE DENTURES-JACKSONVILLE, P.A.
Provider Business Mailing Address
First Line : 10503 SAN JOSE BLVD
Second Line : SUITE 10
City : JACKSONVILLE
State : FL
Zip : 32257-6295
Country : US
Telephone Number : 904-262-3695
Fax Number : 904-262-3906
Provider Business Practice Location Address
First Line : 10503 SAN JOSE BLVD
Second Line : SUITE 10
City : JACKSONVILLE
State : FL
Zip : 32257-6295
Country : US
Telephone Number : 904-262-3695
Fax Number : 904-262-3906
Authorized Official
Title or Position : OWNER
Name : DR. EFTHEMIOS S TELLIOS
Credential : DMD
Telephone Number : 904-262-3695
Provider Enumeration Date : 06/03/2014
Last Update Date : 06/03/2014

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Directions to “AFFORDABLE DENTURES-JACKSONVILLE, P.A. ” Practice Location

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