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General NPI Number Information
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NPI Number | 1023437209
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Entity Type | Individual
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Provider Name | MICHAEL ROBERT PACE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 1612 LANCASTER DR
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City | GRAPEVINE
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State | TX
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Zip | 76051-3544
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Country | US
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Telephone | 817-993-6512
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Fax | 817-488-4483
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Provider Business Mailing Address
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Address Line | 1612 LANCASTER DR
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City | GRAPEVINE
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State | TX
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Zip | 76051-3544
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Country | US
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Telephone | 817-993-6512
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Fax | 817-488-4483
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 36004
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License Number State | TX
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