Bennett C Packard, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8467 Issued in WA

Practice address

1501 S 40TH Ave
Yakima, WA 98908-3963

Phone

(509) 577-8277

Fax

(509) 573-4858

NPI assigned

Oct 10, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in WA

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.

• Packard, Packard & Packard, PS

  dba Creekside Dental

  • General Practice Dentistry
  • Yakima, WA
  • NPI 1811085665
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1861580797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 S 40TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083963",
            "telephone_number": "509-577-8277",
            "fax_number": "509-573-4858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 S 40TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989083963",
            "telephone_number": "509-577-8277",
            "fax_number": "509-573-4858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACKARD",
        "first_name": "BENNETT",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "8467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TPIN",
            "identifier": "92560941",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "898780",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5032214",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADA",
            "identifier": "141990582",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8923821",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "170386",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "8467",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jareka Jolene Pacheco
• Jorge Luis Pacheco Jr., CO 61015379
• Pacific Cataract and Laser Institute Inc PC
• Pacific Medical, Inc. (Pacific Medical Prosthetics & Orthotics)
• Pacific Vascular Incorporated
• David K Packard, DMD
• Owen E Packard, DDS
• Packard, Packard & Packard, PS (Creekside Dental)
• Craig A Padavich, MD
• Bacilio H Padilla, LICSW

• General Practice Dentistry in Yakima, WA
• Providers in Yakima, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.