Provider Demographics
NPI:1750270344
Name:PEDIATRIC DENTAL SPECIALIST OF ACWORTH
Entity type:Organization
Organization Name:PEDIATRIC DENTAL SPECIALIST OF ACWORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DR
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:330-933-7280
Mailing Address - Street 1:320 LYNN DR
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-4639
Mailing Address - Country:US
Mailing Address - Phone:330-933-7280
Mailing Address - Fax:
Practice Address - Street 1:10166 DALLAS ACWORTH HWY
Practice Address - Street 2:SUITE 109
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132
Practice Address - Country:US
Practice Address - Phone:770-230-7020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty