Provider Demographics
NPI:1477793123
Name:AFFORDABLE DENTURES - SOUTH BEND, P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - SOUTH BEND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUDY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:574-271-1060
Mailing Address - Street 1:165 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1199
Mailing Address - Country:US
Mailing Address - Phone:574-271-1060
Mailing Address - Fax:
Practice Address - Street 1:165 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1199
Practice Address - Country:US
Practice Address - Phone:574-271-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010034A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty