MEDICARE: DR. ERIC M PACHECO D.D.S.

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	DD2637	NM

General Provider Information

NPI Number	:	1477745560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC M PACHECO D.D.S.

Provider Business Mailing Address
First Line	:	2503 RIDGE RUNNER RD
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4972
Country	:	US
Telephone Number	:	505-425-6434
Fax Number	:	505-425-6434

Provider Business Practice Location Address
First Line	:	2503 RIDGE RUNNER RD
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4972
Country	:	US
Telephone Number	:	505-425-6434
Fax Number	:	505-425-6434

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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