Provider Demographics
NPI:1275139297
Name:AFFORDABLE DENTURES & IMPLANTS - TITUSVILLE, P.A.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - TITUSVILLE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:321-294-6494
Mailing Address - Street 1:686 CHENEY HWY
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-6959
Mailing Address - Country:US
Mailing Address - Phone:321-294-6494
Mailing Address - Fax:
Practice Address - Street 1:686 CHENEY HWY
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-6959
Practice Address - Country:US
Practice Address - Phone:321-294-6494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty