Maximilian Miles Pacheco, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-5546 Issued in ID

Practice address

1067 S Wells St
Meridian, ID 83642-8596

Phone

(208) 895-8486

NPI assigned

Jul 10, 2023

Last updated

Aug 23, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dentists of Boise and Orthodontics, PC

  dba Dentists of Boise and Orthodontics

  • General Practice Dentistry
  • Boise, ID
  • NPI 1235747338
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1306524160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1067 S WELLS ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428596",
            "telephone_number": "208-895-8486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1067 S WELLS ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428596",
            "telephone_number": "208-895-8486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACHECO",
        "first_name": "MAXIMILIAN",
        "middle_name": "MILES",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-10",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-5546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marguerite Overton, CRNA
• Owens Medical PLLC
• P. Roman Burk DPM PC (Mountain Pharmacy)
• P. Roman Burk DPM PC (Rocky Mountaint Foot & Ankle)
• Janet A Pace, LCSW
• Pacific Mind Institute
• Pacific Northwest Counseling
• Sarah Pagano, CPM, LM
• Katherine Pages, PHARMD
• Ellen Connolly Paget, ARNP

• General Practice Dentistry in Meridian, ID
• Providers in Meridian, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.