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General NPI Number Information
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NPI Number | 1215553565
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Entity Type | Individual
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Provider Name | ANDREW EUGENE PAK DMD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2020
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 2317 W UNIVERSITY DR STE 149
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City | DENTON
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State | TX
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Zip | 76201-1613
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Country | US
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Telephone | 940-566-0127
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Fax |
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Provider Business Mailing Address
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Address Line | 12013 DRAIN DR
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City | NEWARK
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State | TX
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Zip | 76071-8948
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Country | US
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Telephone | 682-554-1648
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D010719
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 38130
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License Number State | TX
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