MEDICARE: DR. WIL B PACHECO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1606	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124184213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WIL B PACHECO DDS

Provider Business Mailing Address
First Line	:	PO BOX 349
Second Line	:
City	:	FORT SUMNER
State	:	NM
Zip	:	88119-0349
Country	:	US
Telephone Number	:	575-355-2414
Fax Number	:

Provider Business Practice Location Address
First Line	:	546 N 10TH STREET
Second Line	:
City	:	FORT SUMNER
State	:	NM
Zip	:	88119
Country	:	US
Telephone Number	:	575-355-2414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2006
Last Update Date	:	08/06/2013

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