Provider Demographics
NPI:1881268118
Name:THOMAS PACHECO, DDS, INC.
Entity type:Organization
Organization Name:THOMAS PACHECO, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-524-2283
Mailing Address - Street 1:1137 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2505
Mailing Address - Country:US
Mailing Address - Phone:626-584-3031
Mailing Address - Fax:
Practice Address - Street 1:1137 E GREEN ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2505
Practice Address - Country:US
Practice Address - Phone:626-584-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty