Provider Demographics
NPI:1952837189
Name:ACE DENTAL06, PC
Entity Type:Organization
Organization Name:ACE DENTAL06, PC
Other - Org Name:ACE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AC
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKRAVARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-925-0210
Mailing Address - Street 1:1428 WOODED ACRES DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4500
Mailing Address - Country:US
Mailing Address - Phone:201-925-0210
Mailing Address - Fax:
Practice Address - Street 1:1428 WOODED ACRES DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4500
Practice Address - Country:US
Practice Address - Phone:201-925-0210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-09
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty