Provider Demographics
NPI:1346793668
Name:PANUCCI & JACKFERT ORTHODONTICS, INC.
Entity Type:Organization
Organization Name:PANUCCI & JACKFERT ORTHODONTICS, INC.
Other - Org Name:PANUCCI & JACKFERT, DDS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PANUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-744-6311
Mailing Address - Street 1:133 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1417
Mailing Address - Country:US
Mailing Address - Phone:304-744-6311
Mailing Address - Fax:304-744-8832
Practice Address - Street 1:133 7TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1417
Practice Address - Country:US
Practice Address - Phone:304-744-6311
Practice Address - Fax:304-744-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty