Provider Demographics
NPI:1598944993
Name:PANLILIO, MARY THERESA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESA
Last Name:PANLILIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 FREMONT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955
Mailing Address - Country:US
Mailing Address - Phone:831-393-2633
Mailing Address - Fax:831-393-2677
Practice Address - Street 1:1249 FREMONT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955
Practice Address - Country:US
Practice Address - Phone:831-393-2633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist