Provider Demographics
NPI:1104226315
Name:AFFORDABLE DENTURES-EVANSVILLE V, P.C.
Entity type:Organization
Organization Name:AFFORDABLE DENTURES-EVANSVILLE V, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SKIRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-475-2880
Mailing Address - Street 1:619 N BURKHARDT RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7296
Mailing Address - Country:US
Mailing Address - Phone:812-475-2880
Mailing Address - Fax:812-475-3002
Practice Address - Street 1:619 N BURKHARDT RD
Practice Address - Street 2:SUITE A
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7296
Practice Address - Country:US
Practice Address - Phone:812-475-2880
Practice Address - Fax:812-475-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011768A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty