Provider Demographics
NPI:1972511830
Name:MARC A PACHECO DDS LLC
Entity Type:Organization
Organization Name:MARC A PACHECO DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-898-7440
Mailing Address - Street 1:2600 THE AMERICAN RD SE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1849
Mailing Address - Country:US
Mailing Address - Phone:505-898-7440
Mailing Address - Fax:505-898-6169
Practice Address - Street 1:2600 THE AMERICAN RD SE
Practice Address - Street 2:SUITE 230
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1849
Practice Address - Country:US
Practice Address - Phone:505-898-7440
Practice Address - Fax:505-898-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty