Provider Demographics
NPI:1497804611
Name:PACHECO, ANTONIO MARTIN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:MARTIN
Last Name:PACHECO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8500 BLUFFSTONE CV STE B203
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7812
Mailing Address - Country:US
Mailing Address - Phone:512-345-9229
Mailing Address - Fax:512-231-0596
Practice Address - Street 1:8500 BLUFFSTONE CV STE B203
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7812
Practice Address - Country:US
Practice Address - Phone:512-345-9229
Practice Address - Fax:512-231-0596
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice