Provider Demographics
NPI:1699815852
Name:PACOFSKY, TODD WEBSTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:WEBSTER
Last Name:PACOFSKY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 FENTON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3516
Mailing Address - Country:US
Mailing Address - Phone:619-216-1100
Mailing Address - Fax:619-216-1127
Practice Address - Street 1:2446 FENTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3516
Practice Address - Country:US
Practice Address - Phone:619-216-1100
Practice Address - Fax:619-216-1127
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD50503Medicaid