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General NPI Number Information
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NPI Number | 1891788246
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Entity Type | Individual
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Provider Name | PAMELA M BACA DDS
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Gender | Female
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3031 HOT SPRINGS BLVD
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City | LAS VEGAS
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State | NM
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Zip | 87701-4120
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Country | US
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Telephone | 505-425-6677
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Fax | 505-425-9638
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Provider Business Mailing Address
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Address Line | 111 N RAILROAD AVE P.O. BOX 158
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City | ESPANOLA
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State | NM
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Zip | 87532-2627
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Country | US
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Telephone | 505-753-7218
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Fax | 505-753-5815
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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 | DD1719
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License Number State | NM
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