Provider Demographics
NPI:1922010503
Name:AFFORDABLE DENTURES - ERIE II, P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - ERIE II, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENITIST/MANAGING DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERIF
Authorized Official - Middle Name:FAYEZ FAHMY
Authorized Official - Last Name:KERIAKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:814-833-7540
Mailing Address - Street 1:1101 PENINSULA DR
Mailing Address - Street 2:PENINSULA PLAZA SHOPPING CENTER, STE #210
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505
Mailing Address - Country:US
Mailing Address - Phone:814-833-7540
Mailing Address - Fax:814-833-6455
Practice Address - Street 1:1101 PENINSULA DR
Practice Address - Street 2:PENINSULA PLAZA SHOPPING CENTER, STE #210
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505
Practice Address - Country:US
Practice Address - Phone:814-833-7540
Practice Address - Fax:814-833-6455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030754L PA261QD0000X
CA51851261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019205030001Medicaid