Healthcare Provider Details

I. General information

NPI: 1760739403
Provider Name (Legal Business Name): ALLISON MARIE PACHINA R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 COVINGTON DR
LEMONT IL
60439-8565
US

IV. Provider business mailing address

1095 COVINGTON DR
LEMONT IL
60439-8565
US

V. Phone/Fax

Practice location:
  • Phone: 630-901-0163
  • Fax:
Mailing address:
  • Phone: 630-901-0163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number020014142
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: