Provider Demographics
NPI:1922125137
Name:PACHON, SANDRA (DDS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PACHON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-2241
Mailing Address - Country:US
Mailing Address - Phone:973-473-0900
Mailing Address - Fax:973-772-3989
Practice Address - Street 1:1219 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2241
Practice Address - Country:US
Practice Address - Phone:973-473-0900
Practice Address - Fax:973-772-3989
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020230001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice