Provider Demographics
NPI:1689406449
Name:AFFORDABLE DENTURES & IMPLANTS - WEST ST. PAUL IV, P.C.
Entity type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - WEST ST. PAUL IV, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-552-6770
Mailing Address - Street 1:2055 ROBERT ST S
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3924
Mailing Address - Country:US
Mailing Address - Phone:651-552-6770
Mailing Address - Fax:
Practice Address - Street 1:2055 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3924
Practice Address - Country:US
Practice Address - Phone:651-552-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty