Provider Demographics
NPI:1982017471
Name:AFFORDABLE DENTURES-JACKSONVILLE, P.A.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES-JACKSONVILLE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EFTHEMIOS
Authorized Official - Middle Name:S
Authorized Official - Last Name:TELLIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-262-3695
Mailing Address - Street 1:10503 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-6295
Mailing Address - Country:US
Mailing Address - Phone:904-262-3695
Mailing Address - Fax:904-262-3906
Practice Address - Street 1:10503 SAN JOSE BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6295
Practice Address - Country:US
Practice Address - Phone:904-262-3695
Practice Address - Fax:904-262-3906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty