Provider Demographics
NPI:1386827707
Name:MARC PANA PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:MARC PANA PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:PANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:310-435-5622
Mailing Address - Street 1:6 HUGHES
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2059
Mailing Address - Country:US
Mailing Address - Phone:877-358-3915
Mailing Address - Fax:949-680-1881
Practice Address - Street 1:6 HUGHES
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2059
Practice Address - Country:US
Practice Address - Phone:877-358-3915
Practice Address - Fax:949-680-1881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043368517OtherPERSONAL NPI