Provider Demographics
NPI:1164912739
Name:AFFORDABLE DENTURES & IMPLANTS - WEST ATLANTA, P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - WEST ATLANTA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUNFISAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-691-3742
Mailing Address - Street 1:3695 CASCADE RD SW STE 550
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2176
Mailing Address - Country:US
Mailing Address - Phone:404-691-3742
Mailing Address - Fax:
Practice Address - Street 1:3695 CASCADE RD SW STE 550
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2176
Practice Address - Country:US
Practice Address - Phone:404-691-3742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty