Provider Demographics
NPI:1700051968
Name:PASCO, CONNIE MILLARE (DMD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:MILLARE
Last Name:PASCO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S GRAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3999
Mailing Address - Country:US
Mailing Address - Phone:323-669-4346
Mailing Address - Fax:
Practice Address - Street 1:150 N RENO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4656
Practice Address - Country:US
Practice Address - Phone:213-380-7298
Practice Address - Fax:213-385-5431
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice