Basic Information
| Provider Information | |||||||||
| NPI: | 1790983534 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PACIA | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CLAIRE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 580 COLONIAL AVE | ||||||||
| Address2: | |||||||||
| City: | PELHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108032120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147382195 | ||||||||
| FaxNumber: | 9147385789 | ||||||||
| Practice Location | |||||||||
| Address1: | 2094 ALBANY POST RD | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105481454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 08/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 054103 | NY | Y | Dental Providers | Dentist | 122300000X | 009791 | CT | N | Dental Providers | Dentist |
No ID Information.