Provider Demographics
NPI:1821115981
Name:PACIA DENTAL CORPORATION
Entity Type:Organization
Organization Name:PACIA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:NAGUIT
Authorized Official - Last Name:PACIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-368-4661
Mailing Address - Street 1:16905 SAN FERNANDO MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4250
Mailing Address - Country:US
Mailing Address - Phone:818-368-4661
Mailing Address - Fax:818-368-1344
Practice Address - Street 1:16905 SAN FERNANDO MISSION BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4250
Practice Address - Country:US
Practice Address - Phone:818-368-4661
Practice Address - Fax:818-368-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92240-01OtherMEDICAL/DENTI-CAL