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General NPI Number Information
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NPI Number | 1427551837
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Entity Type | Individual
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Provider Name | TIFFANY PACHECO
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Gender | Female
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 5250 LEETSDALE DR
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City | DENVER
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State | CO
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Zip | 80246-1438
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Country | US
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Telephone | 303-954-0058
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 S SYRACUSE WAY APT 2-303
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City | DENVER
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State | CO
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Zip | 80231-4297
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Country | US
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Telephone |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH.002024837
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License Number State | CO
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