Provider Demographics
NPI:1013349505
Name:PACHECO, JENNIFER MARIE (RDH)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:MARIE
Last Name:PACHECO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4353 N COLPIEN RD
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-9627
Mailing Address - Country:US
Mailing Address - Phone:559-331-7630
Mailing Address - Fax:
Practice Address - Street 1:4353 N COLPIEN RD
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-9627
Practice Address - Country:US
Practice Address - Phone:559-331-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27601124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist