Provider Demographics
NPI:1346389012
Name:AFFORDABLE DENTURES- LAFAYETTE, P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES- LAFAYETTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-446-8474
Mailing Address - Street 1:3861 STATE ROAD 26 E STE 1
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-7201
Mailing Address - Country:US
Mailing Address - Phone:765-446-8474
Mailing Address - Fax:
Practice Address - Street 1:3861 STATE ROAD 26 E STE 1
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-7201
Practice Address - Country:US
Practice Address - Phone:765-446-8474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010233B122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty