Provider Demographics
NPI:1053820522
Name:PANNU AND HENNE DENTAL CORP.
Entity Type:Organization
Organization Name:PANNU AND HENNE DENTAL CORP.
Other - Org Name:GREAT SMILES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & PARTNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DALVIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:PANNU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-826-1144
Mailing Address - Street 1:3219 MC HENRY AVE, SUITE E
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-409-8987
Mailing Address - Fax:209-322-4749
Practice Address - Street 1:3219 MC HENRY AVE, SUITE E
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-409-8987
Practice Address - Fax:209-322-4749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty