Provider Demographics
NPI:1477745560
Name:PACHECO, ERIC M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:PACHECO
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 1:2503 RIDGE RUNNER RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4972
Mailing Address - Country:US
Mailing Address - Phone:505-425-6434
Mailing Address - Fax:505-425-6434
Practice Address - Street 1:2503 RIDGE RUNNER RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4972
Practice Address - Country:US
Practice Address - Phone:505-425-6434
Practice Address - Fax:505-425-6434
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD26371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice