Healthcare Provider Details

I. General information

NPI: 1083684823
Provider Name (Legal Business Name): STEPHEN MICHAEL PACHUTA D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3D DENTAL BATTALION/USNDC OKINAWA UNIT 38450
FPO AP
96604-8450
JP

IV. Provider business mailing address

PSC 482 BOX 3016
FPO AP
96362
JP

V. Phone/Fax

Practice location:
  • Phone: 011816117453499
  • Fax:
Mailing address:
  • Phone: 011816117465851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2841
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: