Provider Demographics
NPI:1316178619
Name:PANOS DENTISTRY CENTER
Entity Type:Organization
Organization Name:PANOS DENTISTRY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-577-2100
Mailing Address - Street 1:4849 N MILWAUKEE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2171
Mailing Address - Country:US
Mailing Address - Phone:773-577-2100
Mailing Address - Fax:
Practice Address - Street 1:4849 N MILWAUKEE AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2171
Practice Address - Country:US
Practice Address - Phone:773-577-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty