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General NPI Number Information
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NPI Number | 1023183035
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Entity Type | Organization
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Legal Business Name | ACE ORTHODONTICS AND DENTISTRY,LLC
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1922 HIGHWAY 74 N STE. E
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City | TYRONE
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State | GA
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Zip | 30290-1660
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Country | US
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Telephone | 770-892-2110
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Fax | 770-892-2126
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Provider Business Mailing Address
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Address Line | 1922 HIGHWAY 74 N STE. E
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City | TYRONE
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State | GA
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Zip | 30290-1660
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Country | US
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Telephone | 770-892-2110
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Fax | 770-892-2126
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL WASHINGTON LINDO
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Credential | D.D.S.
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Telephone | 770-892-2110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 011348
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License Number State | GA
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