Pako M Major, DDS
Individual provider Active NPI Dentist · Jackson, WI
NPI 1003116278 · NPPES record last updated Sep 17, 2019
Key facts
- NPI
- 1003116278
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6616-15 (WI)
- Practice address
- N168W20060 Main St
Jackson, WI 53037-9380 - Phone
- (262) 677-3003
- NPI assigned
- Oct 22, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160414000817 | NM | Order and Referring Only - Dentist |
7214235860 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6616-15 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alegre Dental | Past | Accepting new patients | |
| New Mexico Professional Dental Associates, Inc | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DD3443 | NM | |
| General Practice Dentistry | 1223G0001X | 6616-15 | WI | |
| Dentist | 122300000X | 6616-15 | WI | Yes |
Addresses
Primary practice location
N168W20060 Main St
Jackson, WI 53037-9380
Mailing address
2116 Vista Oeste NW Ste 202
Albuquerque, NM 87120-4341
Phone (414) 699-5506
Other providers in Jackson, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.