Provider Demographics
NPI:1467732941
Name:AFFORDABLE DENTURES - LITCHFIELD, P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - LITCHFIELD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEIF
Authorized Official - Middle Name:F
Authorized Official - Last Name:ENGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-324-0372
Mailing Address - Street 1:1403 W FERDON ST STE 22
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-4448
Mailing Address - Country:US
Mailing Address - Phone:217-324-0372
Mailing Address - Fax:217-324-0375
Practice Address - Street 1:1403 W FERDON ST STE 22
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-4448
Practice Address - Country:US
Practice Address - Phone:217-324-0372
Practice Address - Fax:217-324-0375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty