Provider Demographics
NPI:1215553565
Name:PAK, ANDREW EUGENE (DMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:EUGENE
Last Name:PAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12013 DRAIN DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:TX
Mailing Address - Zip Code:76071-8948
Mailing Address - Country:US
Mailing Address - Phone:682-554-1648
Mailing Address - Fax:
Practice Address - Street 1:2317 W UNIVERSITY DR STE 149
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-1613
Practice Address - Country:US
Practice Address - Phone:940-566-0127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0107191223G0001X
TX381301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice