Provider Demographics
NPI:1457435117
Name:CONNIE MILLARE PASCO DMD INC
Entity type:Organization
Organization Name:CONNIE MILLARE PASCO DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:MILLARE
Authorized Official - Last Name:PASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:415-587-5763
Mailing Address - Street 1:4804 MISSION STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112
Mailing Address - Country:US
Mailing Address - Phone:415-587-5763
Mailing Address - Fax:415-587-5049
Practice Address - Street 1:4804 MISSION STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112
Practice Address - Country:US
Practice Address - Phone:415-587-5763
Practice Address - Fax:415-587-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty