Provider Demographics
NPI:1407539133
Name:PAN DENTAL SERVICES PLLC
Entity Type:Organization
Organization Name:PAN DENTAL SERVICES PLLC
Other - Org Name:PINE AVENUE SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-855-1007
Mailing Address - Street 1:190 PINE AVE N
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4629
Mailing Address - Country:US
Mailing Address - Phone:813-855-1007
Mailing Address - Fax:813-855-1009
Practice Address - Street 1:190 PINE AVE N
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-4629
Practice Address - Country:US
Practice Address - Phone:813-855-1007
Practice Address - Fax:813-855-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental