NPIMap

Organization Active NPI

Pacheco Family Dentistry LLC

  • General Practice Dentistry
  • Tucumcari, NM
National Provider Identifier
1689290983
Registry record updated Jun 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PACHECO FAMILY DENTISTRY LLC
Practice address
501 S 2ND St
Tucumcari, NM 88401-2861
Phone
(623) 383-3839
NPI assigned
Jun 22, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2020

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

Authorized official

Name
Dr. Victor Matthew Pacheco, DMDNPI 1346735412
Title
Ceo
Phone
(623) 383-3839

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

501 S 2ND St
Tucumcari, NM 88401-2861

Mailing address

501 S 2ND St
Tucumcari, NM 88401-2861
Phone (623) 383-3839

Other identifiers 1

IdentifierTypeStateIssuer
53034091MedicaidNM

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vpacheco94@midwestern.edu

National Provider Directory

National Provider Directory

Locations

501 S 2nd St
Tucumcari, NM 88401
Phone (505) 461-1670

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592784000000",
    "number": "1689290983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S 2ND ST",
            "city": "TUCUMCARI",
            "state": "NM",
            "postal_code": "884012861",
            "telephone_number": "623-383-3839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S 2ND ST",
            "city": "TUCUMCARI",
            "state": "NM",
            "postal_code": "884012861",
            "telephone_number": "623-383-3839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACHECO FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-22",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A",
        "authorized_official_last_name": "PACHECO",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "623-383-3839",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53034091",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vpacheco94@midwestern.edu",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "6370 Quay Road Ar",
            "city": "Tucumcari",
            "state": "NM",
            "country_code": "US",
            "postal_code": "884019529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tucumcari, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.