Provider Demographics
NPI:1386170363
Name:LIDA PAEZ, DMD, LLC
Entity type:Organization
Organization Name:LIDA PAEZ, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDA
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-938-0232
Mailing Address - Street 1:3640 CHAMBLEE TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4418
Mailing Address - Country:US
Mailing Address - Phone:770-938-0232
Mailing Address - Fax:770-938-0681
Practice Address - Street 1:3640 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4418
Practice Address - Country:US
Practice Address - Phone:770-938-0232
Practice Address - Fax:770-938-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014786122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty