Organization
SAN MIGUEL DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILFRED B PACHECO DDS (OWNER)
(505) 425-6434
Entity
Organization
Contact information
Practice address
2503 RIDGE RUNNER RD, LAS VEGAS, NM 87701-4972
(505) 425-6434
(505) 425-6464
Mailing address
2503 RIDGE RUNNER RD, LAS VEGAS, NM 87701-4972
(505) 425-6434
(505) 425-6464
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD1606
NM
Other
Enumeration date
04/29/2011
Last updated
04/29/2011
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