MEDICARE: THREE ACES, LLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1366273062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE ACES, LLC

Provider Business Mailing Address
First Line	:	7320 FOREST OAKS BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-2401
Country	:	US
Telephone Number	:	352-596-1771
Fax Number	:	352-596-6067

Provider Business Practice Location Address
First Line	:	180 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-5689
Country	:	US
Telephone Number	:	352-833-7855
Fax Number	:	352-600-8762

Authorized Official
Title or Position	:	BUSINESS ADMINISTRATOR
Name	:	KIMETHA R HECKMAN
Credential	:
Telephone Number	:	352-596-1771

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	08/13/2024

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Directions to “THREE ACES, LLC ” Practice Location

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