# SAN MIGUEL DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033400601
- **Authorized official:** DR. WILFRED B PACHECO DDS (OWNER)
- **Authorized official phone:** (505) 425-6434

## Contact information

- **Practice address:** 2503 RIDGE RUNNER RD, LAS VEGAS, NM 87701-4972
- **Practice address phone:** (505) 425-6434
- **Practice address fax:** (505) 425-6464
- **Mailing address:** 2503 RIDGE RUNNER RD, LAS VEGAS, NM 87701-4972
- **Mailing address phone:** (505) 425-6434
- **Mailing address fax:** (505) 425-6464

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DD1606 | NM | Yes |

## Other

- **Enumeration date:** 04/29/2011
- **Last updated:** 04/29/2011