Provider Demographics
NPI:1083684823
Name:PACHUTA, STEPHEN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:PACHUTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 482 BOX 3016
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96362
Mailing Address - Country:JP
Mailing Address - Phone:01181611-746-5851
Mailing Address - Fax:
Practice Address - Street 1:3D DENTAL BATTALION/USNDC OKINAWA
Practice Address - Street 2:UNIT 38450
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604-8450
Practice Address - Country:JP
Practice Address - Phone:01181611-745-3499
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice