MEDICARE: DR. LIDA PAEZ DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN014786	GA

General Provider Information

NPI Number	:	1194132308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIDA PAEZ DMD

Provider Business Mailing Address
First Line	:	2400 PARKLAND DR NE
Second Line	:	UNIT 118
City	:	ATLANTA
State	:	GA
Zip	:	30324-3589
Country	:	US
Telephone Number	:	678-641-7989
Fax Number	:

Provider Business Practice Location Address
First Line	:	3970 FIVE FORKS TRICKUM RD SW
Second Line	:	SUITE B
City	:	LILBURN
State	:	GA
Zip	:	30047-2339
Country	:	US
Telephone Number	:	770-921-8442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2014
Last Update Date	:	07/20/2014

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