Provider Demographics
NPI:1902875313
Name:PACHUTA, RENE A (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:A
Last Name:PACHUTA
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 482 BOX 3016
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:OKINAWA
Mailing Address - Zip Code:96362
Mailing Address - Country:JP
Mailing Address - Phone:0118-161-1745
Mailing Address - Fax:745-6187
Practice Address - Street 1:PSC 482
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:OKINAWA
Practice Address - Zip Code:96362
Practice Address - Country:JP
Practice Address - Phone:0118-161-1743
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD 2632124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist