Provider Demographics
NPI:1689188807
Name:PACIFICO DENTAL CARE OF FORKS
Entity Type:Organization
Organization Name:PACIFICO DENTAL CARE OF FORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PACIFICO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-810-3511
Mailing Address - Street 1:2202 SULLIVAN TRAIL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040
Mailing Address - Country:US
Mailing Address - Phone:610-810-3511
Mailing Address - Fax:
Practice Address - Street 1:2202 SULLIVAN TRAIL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040
Practice Address - Country:US
Practice Address - Phone:484-695-8790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental