Provider Demographics
NPI:1114065059
Name:AFFORDABLE DENTURES - GAINESVILLE, P.A.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - GAINESVILLE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOWSTARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-376-8229
Mailing Address - Street 1:4401 NW 25TH PL STE G
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6569
Mailing Address - Country:US
Mailing Address - Phone:352-376-8229
Mailing Address - Fax:
Practice Address - Street 1:4401 NW 25TH PL STE G
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6569
Practice Address - Country:US
Practice Address - Phone:352-376-8229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty