Individual
DR. JONATHAN MICHAEL PANICHELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.,M.S.
Contact information
Practice address
239 MAIN ST, NORTHPORT, NY 11768-1730
(631) 754-1745
(631) 754-3127
Mailing address
66 LOCUST LN, NORTHPORT, NY 11768-1149
(631) 754-1745
(631) 754-3127
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
045759
NY
Other
Enumeration date
03/04/2007
Last updated
07/08/2007
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