Provider Demographics
NPI:1386031169
Name:MARK PANNETON DDS PC
Entity Type:Organization
Organization Name:MARK PANNETON DDS PC
Other - Org Name:PANNETON DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANNETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-934-5200
Mailing Address - Street 1:18140 BURKE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022
Mailing Address - Country:US
Mailing Address - Phone:402-934-5200
Mailing Address - Fax:402-537-4346
Practice Address - Street 1:18140 BURKE ST STE 100
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022
Practice Address - Country:US
Practice Address - Phone:402-934-5200
Practice Address - Fax:402-537-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE55271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty