Provider Demographics
NPI:1881005411
Name:AFFORDABLE DENTURES-PENSCOLA, P.A.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES-PENSCOLA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YIQIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-478-5605
Mailing Address - Street 1:8102 N DAVIS HWY
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6083
Mailing Address - Country:US
Mailing Address - Phone:850-478-5605
Mailing Address - Fax:850-478-5606
Practice Address - Street 1:8102 N DAVIS HWY
Practice Address - Street 2:SUITE 14
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6083
Practice Address - Country:US
Practice Address - Phone:850-478-5605
Practice Address - Fax:850-478-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17855122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty