Provider Demographics
NPI:1124360599
Name:AFFORDABLE GENERAL DENTISTRY,P.C.
Entity type:Organization
Organization Name:AFFORDABLE GENERAL DENTISTRY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:OMAR
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:585-236-3135
Mailing Address - Street 1:198 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4921
Mailing Address - Country:US
Mailing Address - Phone:716-649-5280
Mailing Address - Fax:716-649-5281
Practice Address - Street 1:198 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4921
Practice Address - Country:US
Practice Address - Phone:716-649-5280
Practice Address - Fax:716-649-5281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0530071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty