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NPI Code Detail

MEDICARE: DR. DAVID OPACK D.D.S

MEDICARE: DR. DAVID OPACK D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDD4106NM

General Provider Information

NPI Number : 1104231752
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID OPACK D.D.S
Provider Business Mailing Address
First Line : 350 N CLARK ST FL 6
Second Line :
City : CHICAGO
State : IL
Zip : 60654-4712
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4201 CENTRAL AVE NW STE F1
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87105-1669
Country : US
Telephone Number : 505-843-7172
Fax Number : 505-352-6689
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2014
Last Update Date : 06/23/2014

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Directions to “ DR. DAVID OPACK D.D.S” Practice Location

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