Provider Demographics
NPI:1205230976
Name:ACE DENTAL CARE, LLC
Entity Type:Organization
Organization Name:ACE DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:TALANKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-562-1555
Mailing Address - Street 1:3450 OLD MILTON PKWY
Mailing Address - Street 2:110
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:678-592-8433
Mailing Address - Fax:
Practice Address - Street 1:7990 TURNBERRY WAY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1634
Practice Address - Country:US
Practice Address - Phone:678-592-8433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty