Provider Demographics
NPI:1376819102
Name:AFFORDABLE DENTURES LAGRANGE, P.C
Entity type:Organization
Organization Name:AFFORDABLE DENTURES LAGRANGE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLETHA
Authorized Official - Middle Name:DOSS
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-882-0322
Mailing Address - Street 1:1300 LAFAYETTE PKWY
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-2610
Mailing Address - Country:US
Mailing Address - Phone:706-882-0322
Mailing Address - Fax:706-882-0324
Practice Address - Street 1:1300 LAFAYETTE PKWY
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-2610
Practice Address - Country:US
Practice Address - Phone:706-882-0322
Practice Address - Fax:706-882-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN 012841122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty