Provider Demographics
NPI:1467568733
Name:SINGH, PANKAJ PAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:PANKAJ
Middle Name:PAL
Last Name:SINGH
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 1:4 IVY CT
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-3133
Mailing Address - Country:US
Mailing Address - Phone:516-484-9631
Mailing Address - Fax:516-723-9286
Practice Address - Street 1:800 WOODBURY RD STE D
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2503
Practice Address - Country:US
Practice Address - Phone:516-921-8010
Practice Address - Fax:516-484-9632
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY450221223X2210X, 1223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X2210XDental ProvidersDentistOrofacial Pain
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
45022OtherLINCENSE