Provider Demographics
NPI:1659000578
Name:AFFORDABLE DENTURES & IMPLANTS OF GEORGIA, LLC
Entity type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS OF GEORGIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLAJUMOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEDOYIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-783-1446
Mailing Address - Street 1:5370 STONE MOUNTAIN HWY STE 1120
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3575
Mailing Address - Country:US
Mailing Address - Phone:770-783-1446
Mailing Address - Fax:
Practice Address - Street 1:5370 STONE MOUNTAIN HWY STE 1120
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3575
Practice Address - Country:US
Practice Address - Phone:770-783-1446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty