Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6616-15 | WI |
N | 122300000X | Dentist | DD3443 | NM |
N | 1223G0001X | General Practice | 6616-15 | WI |
N | 213EG0000X | General Practice | 6616-15 | WI |
NPI | 1003116278 |
---|---|
Provider Name | Dr. Pako M Major |
First Address | Albuquerque, NM 87120-4341 |
Second Address | Jackson, WI 53037-9380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2010 |
Last Update Date | 17/09/2019 |