Healthcare Provider Details

I. General information

NPI: 1043452923
Provider Name (Legal Business Name): DAVE C PAK DMD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WASHINGTON ST
ROCHESTER NH
03839-5505
US

IV. Provider business mailing address

123 WASHINGTON ST
ROCHESTER NH
03839-5505
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-0818
  • Fax: 603-332-1204
Mailing address:
  • Phone: 603-332-0818
  • Fax: 603-332-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number03699
License Number StateNH

VIII. Authorized Official

Name: DR. DAVE C PAK
Title or Position: DOCTOR/OWNER
Credential: DMD MD
Phone: 603-332-0818