Provider Demographics
NPI:1487897575
Name:ECONOMY DENTURES OF HUDSON LLC
Entity type:Organization
Organization Name:ECONOMY DENTURES OF HUDSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:R
Authorized Official - Last Name:POLITE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-696-6767
Mailing Address - Street 1:1680 DUNN AVE
Mailing Address - Street 2:SUITE 31
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4782
Mailing Address - Country:US
Mailing Address - Phone:904-696-6767
Mailing Address - Fax:
Practice Address - Street 1:12123 LITTLE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-2924
Practice Address - Country:US
Practice Address - Phone:727-862-5474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ECONOMY DENTURES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 82431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty