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General NPI Number Information
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NPI Number | 1750270344
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL SPECIALIST OF ACWORTH
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 10166 DALLAS ACWORTH HWY SUITE 109
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City | DALLAS
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State | GA
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Zip | 30132
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Country | US
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Telephone | 770-230-7020
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Fax |
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Provider Business Mailing Address
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Address Line | 320 LYNN DR
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City | HIRAM
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State | GA
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Zip | 30141-4639
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Country | US
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Telephone | 330-933-7280
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Fax |
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Authorized Official
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Title or Position | OWNER / DR
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Name | MINDY L SIMMS
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Credential | DMD
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Telephone | 330-933-7280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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