Provider Demographics
NPI:1043452923
Name:DAVE C PAK DMD MD PA
Entity Type:Organization
Organization Name:DAVE C PAK DMD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MD
Authorized Official - Phone:603-332-0818
Mailing Address - Street 1:123 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03839-5505
Mailing Address - Country:US
Mailing Address - Phone:603-332-0818
Mailing Address - Fax:603-332-1204
Practice Address - Street 1:123 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03839-5505
Practice Address - Country:US
Practice Address - Phone:603-332-0818
Practice Address - Fax:603-332-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03699261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery