Provider Demographics
NPI:1982883682
Name:ACE DENTAL
Entity Type:Organization
Organization Name:ACE DENTAL
Other - Org Name:ACE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-442-4044
Mailing Address - Street 1:3420 ALDINE MAIL ROUTE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77039-4636
Mailing Address - Country:US
Mailing Address - Phone:281-442-4044
Mailing Address - Fax:281-442-4034
Practice Address - Street 1:3420 ALDINE MAIL ROUTE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-4636
Practice Address - Country:US
Practice Address - Phone:281-442-4044
Practice Address - Fax:281-442-4034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009822002Medicaid
TX150548902Medicaid