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General NPI Number Information
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NPI Number | 1972058428
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Entity Type | Organization
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Legal Business Name | PACHECO & HENRY DDS PS
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 08/24/2016
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Provider Practice Location Address
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Address Line | 4620 BRIDGEPORT WAY W STE B
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4237
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Country | US
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Telephone | 253-564-9633
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Fax |
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Provider Business Mailing Address
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Address Line | 4620 BRIDGEPORT WAY W STE B
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4237
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Country | US
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Telephone | 253-564-9633
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | DARILYN HENRY
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Credential |
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Telephone | 253-564-9633
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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 | DE00005432
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License Number State | WA
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