Provider Demographics
NPI:1952542185
Name:PAK, DAVE C (DMD, MD)
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:C
Last Name:PAK
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-1125
Mailing Address - Country:US
Mailing Address - Phone:603-332-0818
Mailing Address - Fax:603-332-1204
Practice Address - Street 1:248 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-1125
Practice Address - Country:US
Practice Address - Phone:603-332-0818
Practice Address - Fax:603-332-1204
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14303204E00000X
NH036991223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery