Provider Demographics
NPI:1366502999
Name:PANHANDLE DENTAL CARE, PA
Entity Type:Organization
Organization Name:PANHANDLE DENTAL CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LINXWILER
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-763-5817
Mailing Address - Street 1:516 N MACARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3636
Mailing Address - Country:US
Mailing Address - Phone:850-763-5817
Mailing Address - Fax:850-763-0733
Practice Address - Street 1:516 N MACARTHUR AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3636
Practice Address - Country:US
Practice Address - Phone:850-763-5817
Practice Address - Fax:850-763-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty