Provider Demographics
NPI:1184338725
Name:AFFORDABLE DENTURES & IMPLANTS - BULLHEAD CITY V, P.C.
Entity type:Organization
Organization Name:AFFORDABLE DENTURES & IMPLANTS - BULLHEAD CITY V, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIBERA
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:BRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-704-9242
Mailing Address - Street 1:3699 HIGHWAY 95 STE 316B
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-9123
Mailing Address - Country:US
Mailing Address - Phone:928-704-9242
Mailing Address - Fax:
Practice Address - Street 1:3699 HIGHWAY 95 STE 316B
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-9123
Practice Address - Country:US
Practice Address - Phone:928-704-9242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty