Provider Demographics
NPI:1093778516
Name:PANKEY, EUGENE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:R
Last Name:PANKEY
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 1:1225 S GEAR AVE
Mailing Address - Street 2:MERCY PLZ STE 156
Mailing Address - City:W BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1691
Mailing Address - Country:US
Mailing Address - Phone:319-752-2659
Mailing Address - Fax:319-753-0856
Practice Address - Street 1:1225 S GEAR AVE
Practice Address - Street 2:MERCY PLZ STE 156
Practice Address - City:W BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1691
Practice Address - Country:US
Practice Address - Phone:319-752-2659
Practice Address - Fax:319-753-0856
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA64941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1117168Medicaid
IAU51407Medicare UPIN
IA16338Medicare PIN