Provider Demographics
NPI:1073621884
Name:PANNELL, JOHN KEITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEITH
Last Name:PANNELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S WHITE OAK RD
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75693
Mailing Address - Country:US
Mailing Address - Phone:903-297-0712
Mailing Address - Fax:903-759-9056
Practice Address - Street 1:601 S WHITE OAK RD
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:TX
Practice Address - Zip Code:75693
Practice Address - Country:US
Practice Address - Phone:903-297-0712
Practice Address - Fax:903-759-9056
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice