Provider Demographics
NPI:1164717831
Name:AFFORDABLE MEDICAL & DENTAL SUPPLY LLC
Entity Type:Organization
Organization Name:AFFORDABLE MEDICAL & DENTAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF AMDS
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:POLITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-727-3016
Mailing Address - Street 1:1680 DUNN AVE
Mailing Address - Street 2:5
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4782
Mailing Address - Country:US
Mailing Address - Phone:888-727-3016
Mailing Address - Fax:888-522-5943
Practice Address - Street 1:1680 DUNN AVE STE 5
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4788
Practice Address - Country:US
Practice Address - Phone:888-727-3016
Practice Address - Fax:888-522-5943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2080154249098332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies