Provider Demographics
NPI:1528368842
Name:AFFORDABLE DENTURES - IRIS J. WATKINS, DDS, INC.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - IRIS J. WATKINS, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-851-3295
Mailing Address - Street 1:5609 TRABUE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-9567
Mailing Address - Country:US
Mailing Address - Phone:614-851-3295
Mailing Address - Fax:614-851-3297
Practice Address - Street 1:5609 TRABUE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9567
Practice Address - Country:US
Practice Address - Phone:614-851-3295
Practice Address - Fax:614-851-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2018980Medicaid