Individual
MAXIMILIAN MILES PACHECO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1067 S WELLS ST, MERIDIAN, ID 83642-8596
(208) 895-8486
Mailing address
1067 S WELLS ST, MERIDIAN, ID 83642-8596
(208) 895-8486
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-5546
ID
Other
Enumeration date
07/10/2023
Last updated
08/23/2023
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