Provider Demographics
NPI:1578592762
Name:PANAGOS, CHRIS C (DDS)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:C
Last Name:PANAGOS
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 1:18501 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3224
Mailing Address - Country:US
Mailing Address - Phone:313-882-9729
Mailing Address - Fax:313-882-5117
Practice Address - Street 1:18501 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3224
Practice Address - Country:US
Practice Address - Phone:313-882-9729
Practice Address - Fax:313-882-5117
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15987191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice