Provider Demographics
NPI:1811130032
Name:AFFORDABLE DENTURES - WEST PALM BEACH, P.A.
Entity type:Organization
Organization Name:AFFORDABLE DENTURES - WEST PALM BEACH, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUST
Authorized Official - Middle Name:G
Authorized Official - Last Name:KAPETAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-687-1360
Mailing Address - Street 1:6076 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE 20, COLLEGE PLAZA
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4351
Mailing Address - Country:US
Mailing Address - Phone:561-687-1360
Mailing Address - Fax:
Practice Address - Street 1:6076 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE 20, COLLEGE PLAZA
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4351
Practice Address - Country:US
Practice Address - Phone:561-687-1360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty