Provider Demographics
NPI:1073727848
Name:DR. PANESAR
Entity Type:Organization
Organization Name:DR. PANESAR
Other - Org Name:DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PALWINDER
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:PANESAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:207-473-7723
Mailing Address - Street 1:207 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04742-1120
Mailing Address - Country:US
Mailing Address - Phone:207-473-7723
Mailing Address - Fax:
Practice Address - Street 1:207 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04742-1120
Practice Address - Country:US
Practice Address - Phone:207-473-7723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3510261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMAINECAREOther133590000
ME1710921945OtherNPI TYPE 1