Provider Demographics
NPI:1851150981
Name:AFFORDABLE DENTURES & IMPLANTS - VIRGINIA BEACH III, P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - VIRGINIA BEACH III, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUAZZAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-463-5105
Mailing Address - Street 1:3980 VIRGINIA BEACH BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2470
Mailing Address - Country:US
Mailing Address - Phone:757-463-5105
Mailing Address - Fax:
Practice Address - Street 1:3980 VIRGINIA BEACH BLVD STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2470
Practice Address - Country:US
Practice Address - Phone:757-463-5105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty