Provider Demographics
NPI:1568682243
Name:PACHECO, PATRICK M (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
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 1:1406 LUISA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4012
Mailing Address - Country:US
Mailing Address - Phone:505-988-5850
Mailing Address - Fax:505-820-8751
Practice Address - Street 1:1406 LUISA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4012
Practice Address - Country:US
Practice Address - Phone:505-988-5850
Practice Address - Fax:505-820-8751
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM10731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice