Provider Demographics
NPI:1356887400
Name:PACIOS PUJADO, SANDRA (DDS, MS, PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:PACIOS PUJADO
Suffix:
Gender:F
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 CAMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1912
Mailing Address - Country:US
Mailing Address - Phone:215-391-3682
Mailing Address - Fax:
Practice Address - Street 1:3224 CAMBRIDGE CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-1912
Practice Address - Country:US
Practice Address - Phone:215-391-3682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014154451223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics