Provider Demographics
NPI:1558852251
Name:AFFORDABLE DENTURES & IMPLANTS - LAFAYETTE, P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - LAFAYETTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-446-8474
Mailing Address - Street 1:4315 COMMERCE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-3823
Mailing Address - Country:US
Mailing Address - Phone:765-446-8474
Mailing Address - Fax:
Practice Address - Street 1:4315 COMMERCE DR STE 210
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-3823
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:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty