Healthcare Provider Details

I. General information

NPI: 1245786391
Provider Name (Legal Business Name): DENTAL PARTNERS OF ALAMEDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-1936
US

IV. Provider business mailing address

1125 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-1936
US

V. Phone/Fax

Practice location:
  • Phone: 505-681-2237
  • Fax:
Mailing address:
  • Phone: 505-681-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC PACHEO
Title or Position: DOCTOR
Credential:
Phone: 505-681-2237