Provider Demographics
NPI:1194844571
Name:PANNING, BARRY JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:JOHN
Last Name:PANNING
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 1:3001 HARBOR LN N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5102
Mailing Address - Country:US
Mailing Address - Phone:763-553-0451
Mailing Address - Fax:763-559-3425
Practice Address - Street 1:3001 HARBOR LN N
Practice Address - Street 2:SUITE 100
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5102
Practice Address - Country:US
Practice Address - Phone:763-553-0451
Practice Address - Fax:763-559-3425
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist