Provider Demographics
NPI:1407057441
Name:PANOS, GEORGE CHRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CHRIS
Last Name:PANOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N 67 W 31027 CLUB CIRCLE EAST
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029
Mailing Address - Country:US
Mailing Address - Phone:126-236-4744
Mailing Address - Fax:
Practice Address - Street 1:N 67 W 31027 CLUB CIRCLE EAST
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029
Practice Address - Country:US
Practice Address - Phone:126-236-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3806-0151223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology