Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 36004 | TX |
NPI | 1023437209 |
---|---|
Provider Name | Dr. Michael Robert Pace |
First Address | Grapevine, TX 76051-3544 |
Second Address | Grapevine, TX 76051-3544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 01/02/2021 |