Provider Demographics
NPI:1144592064
Name:PANCER, BROOKE ASHLEY (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ASHLEY
Last Name:PANCER
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SAN JOAQUIN PLAZA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:734-763-3389
Mailing Address - Fax:734-763-5503
Practice Address - Street 1:2999 WESTMINSTER BLVD SEAL BEACH DENTAL IMPLANTS
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740
Practice Address - Country:US
Practice Address - Phone:562-431-9739
Practice Address - Fax:734-763-5503
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1024551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics