Provider Demographics
NPI:1639894058
Name:OFICINA DENTAL DR PACHECO LLC
Entity Type:Organization
Organization Name:OFICINA DENTAL DR PACHECO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PACHECO PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-409-7480
Mailing Address - Street 1:COND ARCOS DE SUCHVILLE
Mailing Address - Street 2:80 CALLE 3 APT 310
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960
Mailing Address - Country:US
Mailing Address - Phone:787-409-7480
Mailing Address - Fax:
Practice Address - Street 1:URB SANTA ROSA AVE AGUAS BUENAS
Practice Address - Street 2:20 BLQ 38
Practice Address - City:BAYAMAON
Practice Address - State:PR
Practice Address - Zip Code:00959-0095
Practice Address - Country:US
Practice Address - Phone:787-409-7480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental