Provider Demographics
NPI:1366273062
Name:THREE ACES, LLC
Entity type:Organization
Organization Name:THREE ACES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMETHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-596-1771
Mailing Address - Street 1:7320 FOREST OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-2401
Mailing Address - Country:US
Mailing Address - Phone:352-596-1771
Mailing Address - Fax:352-596-6067
Practice Address - Street 1:180 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5689
Practice Address - Country:US
Practice Address - Phone:352-833-7855
Practice Address - Fax:352-600-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty