Brett L Pack, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DE 00011081 Issued in WA

Practice address

605 S Coolidge St
Moses Lake, WA 98837-1893

Phone

(509) 765-0674

Fax

(509) 766-8993

NPI assigned

Aug 1, 2007

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

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

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

{
    "created_epoch": "1185926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185926400000",
    "number": "1861683112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9039 CASTLEWOOD DR SE",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988378217",
            "telephone_number": "509-765-0870",
            "fax_number": "509-765-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S COOLIDGE ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371893",
            "telephone_number": "509-765-0674",
            "fax_number": "509-766-8993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "BRETT",
        "middle_name": "L",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-01",
        "last_updated": "2007-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE 00011081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenni Mina Michelle Osborne
• Kevin D Osborne, OD
• Momodu Kamaru Oseni, FNP
• Oluwaseun Adetola Osonuga
• Preston J. Ottmar, PHARMD
• Pack'S Delivery LLC
• Juan Padilla, BA
• Ruby Padilla, MSW
• Billie Jo Palmer, MA
• Palouse Medical Transport LLC

• Dentist in Moses Lake, WA
• Providers in Moses Lake, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2007; 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.