Provider Demographics
NPI:1154466753
Name:AFFORDABLE DENTURES - TALLAHASSE, P.A.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - TALLAHASSE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:AMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-385-5188
Mailing Address - Street 1:2810 SHARER RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-2114
Mailing Address - Country:US
Mailing Address - Phone:850-385-5188
Mailing Address - Fax:
Practice Address - Street 1:2810 SHARER RD
Practice Address - Street 2:SUITE 17
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-2114
Practice Address - Country:US
Practice Address - Phone:850-385-5188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15271122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty