Organization
PANOS DENTISTRY CENTER INC.
Active
Organization
PANOS DENTISTRY CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUE PELLETIER (ADMIN ASSISTANCE)
(773) 577-2100
Entity
Organization
Contact information
Practice address
4849 N. MILWAUKEE AVE, SUITE 103, CHICAGO, IL 60630-2171
(773) 577-2100
Mailing address
4849 N. MILWAUKEE AVE, SUITE 103, CHICAGO, IL 60630-2171
(773) 577-2100
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019-020397
IL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
021-000547
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104979533
NATIONAL PROVIDER NUMBER
IL
Enumeration date
09/17/2010
Last updated
09/17/2010
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