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General NPI Number Information
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NPI Number | 1316338205
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Entity Type | Organization
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Legal Business Name | PACIFICO DENTAL CARE LLC
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 48 N 3RD ST
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City | BANGOR
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State | PA
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Zip | 18013-1908
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Country | US
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Telephone | 610-588-2722
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Fax | 610-599-1034
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Provider Business Mailing Address
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Address Line | 48 N 3RD ST
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City | BANGOR
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State | PA
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Zip | 18013-1908
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Country | US
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Telephone | 610-588-2722
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Fax | 610-599-1034
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL L PACIFICO
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Credential | DMD
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Telephone | 610-588-2722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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