Provider Demographics
NPI:1851568430
Name:PACE, MICHAEL KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENT
Last Name:PACE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 AUSTELL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2004
Mailing Address - Country:US
Mailing Address - Phone:770-948-8888
Mailing Address - Fax:770-948-9065
Practice Address - Street 1:4750 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2004
Practice Address - Country:US
Practice Address - Phone:770-948-8888
Practice Address - Fax:770-948-9065
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice