Individual
MRS. KNIEEKA SHANELL JAKE-PACHECO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3111 S TEXAS AVE, BRYAN, TX 77802
(979) 446-0270
(979) 775-7641
Mailing address
3111 S TEXAS AVE, BRYAN, TX 77802-3124
(979) 446-0270
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
200916780
MO
122300000X
Dentist
62350
CA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
29374
TX
Other
Enumeration date
08/28/2009
Last updated
08/28/2018
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