Provider Demographics
NPI:1538302625
Name:AFFORDABLE DENTURES - DAYTONA BEACH, P.A.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - DAYTONA BEACH, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROLLINS
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:386-226-2268
Mailing Address - Street 1:1116B BEVILLE RD
Mailing Address - Street 2:VILLAGE PLAZA
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5743
Mailing Address - Country:US
Mailing Address - Phone:386-226-2268
Mailing Address - Fax:
Practice Address - Street 1:1116B BEVILLE RD
Practice Address - Street 2:VILLAGE PLAZA
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5743
Practice Address - Country:US
Practice Address - Phone:386-226-2268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17796122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty