Individual
DR. PAMELA M BACA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3031 HOT SPRINGS BLVD, LAS VEGAS, NM 87701-4120
(505) 425-6677
(505) 425-9638
Mailing address
111 N RAILROAD AVE, P.O. BOX 158, ESPANOLA, NM 87532-2627
(505) 753-7218
(505) 753-5815
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD1719
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80044
—
NM
01
—
9177330
DORAL
NM
Enumeration date
08/31/2005
Last updated
07/09/2007
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