Pacheco & Henry DDS PS

Primary specialty

DentistTaxonomy code 122300000X

License

DE00005432 Issued in WA

Legal business name

PACHECO & HENRY DDS PS

Doing business as

Bridgeport Family Dentistry

Practice address

4620 Bridgeport Way W Ste B
University Place, WA 98466-4237

Phone

(253) 564-9633

NPI assigned

Aug 24, 2016

Organization subpart

No

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

Authorized official

Name

Darilyn Henry

Title

General Manager

Phone

(253) 564-9633

Specialties & licenses 1

Addresses

Other names 1

• Bridgeport Family Dentistry Doing business as

Locations

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

{
    "created_epoch": "1471996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471996800000",
    "number": "1972058428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4620 BRIDGEPORT WAY W STE B",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664237",
            "telephone_number": "253-564-9633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 BRIDGEPORT WAY W STE B",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664237",
            "telephone_number": "253-564-9633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACHECO & HENRY DDS PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-24",
        "last_updated": "2016-08-24",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "DARILYN",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "253-564-9633"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00005432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridgeport Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in University Place, WA
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• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; 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.