Provider Demographics
NPI:1104145614
Name:PACES FERRY ORAL SURGERY, LLC
Entity type:Organization
Organization Name:PACES FERRY ORAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:AIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:404-351-5335
Mailing Address - Street 1:3280 HOWELL MILL RD NW
Mailing Address - Street 2:#240
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4111
Mailing Address - Country:US
Mailing Address - Phone:404-351-5335
Mailing Address - Fax:404-351-1339
Practice Address - Street 1:3280 HOWELL MILL RD NW
Practice Address - Street 2:#240
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4111
Practice Address - Country:US
Practice Address - Phone:404-351-5335
Practice Address - Fax:404-351-1339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty