Provider Demographics
NPI:1982179743
Name:ACE DENTAL07 PLLC
Entity Type:Organization
Organization Name:ACE DENTAL07 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARONAV
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKRAVARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-925-0210
Mailing Address - Street 1:231 E. ENTERPRISE DR.
Mailing Address - Street 2:UNIT 3
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643
Mailing Address - Country:US
Mailing Address - Phone:201-925-3014
Mailing Address - Fax:
Practice Address - Street 1:231 ENTERPRISE DR.
Practice Address - Street 2:UNIT 3
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643
Practice Address - Country:US
Practice Address - Phone:201-925-3014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29291OtherTSBDE