Provider Demographics
NPI:1720551906
Name:PACTOVIS, HOWARD J
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:J
Last Name:PACTOVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WIMBLEDON CT
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-3026
Mailing Address - Country:US
Mailing Address - Phone:339-927-8992
Mailing Address - Fax:
Practice Address - Street 1:77 GARLAND LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3011
Practice Address - Country:US
Practice Address - Phone:609-880-0082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12904122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist