Provider Demographics
NPI:1700183183
Name:AFFORDABLE DENTURES - WILKES-BARRE, P.C.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - WILKES-BARRE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-825-5120
Mailing Address - Street 1:104 WYOMING VALLEY MALL # PA
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6812
Mailing Address - Country:US
Mailing Address - Phone:570-825-5120
Mailing Address - Fax:
Practice Address - Street 1:104 WYOMING VALLEY MALL # PA
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6812
Practice Address - Country:US
Practice Address - Phone:570-825-5120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-19
Last Update Date:2011-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty