Provider Demographics
NPI:1134447436
Name:PASCO, IRYNA N (RDH)
Entity type:Individual
Prefix:
First Name:IRYNA
Middle Name:N
Last Name:PASCO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 ARBORETUM WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3832
Mailing Address - Country:US
Mailing Address - Phone:617-637-7373
Mailing Address - Fax:
Practice Address - Street 1:6311 KINGSTON PIKE STE 8W
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4906
Practice Address - Country:US
Practice Address - Phone:865-584-7336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH0000007002124Q00000X
MADH87190124Q00000X
MADH1410852-L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist