Provider Demographics
NPI:1992139059
Name:ACE DENTAL LLC
Entity type:Organization
Organization Name:ACE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHLON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-383-9800
Mailing Address - Street 1:3554 HULMEVILLE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4366
Mailing Address - Country:US
Mailing Address - Phone:215-383-9800
Mailing Address - Fax:215-383-0115
Practice Address - Street 1:5616 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2228
Practice Address - Country:US
Practice Address - Phone:215-383-9800
Practice Address - Fax:215-383-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
124Q00000X, 1223G0001X, 1223S0112X, 126800000X
PADS036660122300000X
PADS036680122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty