Provider Demographics
NPI:1033452669
Name:DRS PANCHAL AND HAYGOOD, P.A.
Entity Type:Organization
Organization Name:DRS PANCHAL AND HAYGOOD, P.A.
Other - Org Name:SOUTHEAST SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PARIMAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PANCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:910-859-7529
Mailing Address - Street 1:910 S COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4412
Mailing Address - Country:US
Mailing Address - Phone:910-859-7529
Mailing Address - Fax:910-859-7528
Practice Address - Street 1:910 S COLLEGE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4412
Practice Address - Country:US
Practice Address - Phone:910-859-7529
Practice Address - Fax:910-859-7528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty