Provider Demographics
NPI:1083198865
Name:AFFORDABLE DENTURES - STOCKBRIDGE, P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - STOCKBRIDGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-507-9673
Mailing Address - Street 1:3576 HIGHWAY 138 SE STE C
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7822
Mailing Address - Country:US
Mailing Address - Phone:770-507-9673
Mailing Address - Fax:
Practice Address - Street 1:3576 HIGHWAY 138 SE STE C
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7822
Practice Address - Country:US
Practice Address - Phone:770-507-9673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty