Provider Demographics
NPI:1609997691
Name:PANIS, REMELITA SORIANO (DMD)
Entity Type:Individual
Prefix:DR
First Name:REMELITA
Middle Name:SORIANO
Last Name:PANIS
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 1:2206 LAFAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-2904
Mailing Address - Country:US
Mailing Address - Phone:408-727-2698
Mailing Address - Fax:408-727-2697
Practice Address - Street 1:2206 LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-2904
Practice Address - Country:US
Practice Address - Phone:408-727-2698
Practice Address - Fax:408-727-2697
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADY333781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3337801OtherDENTICAL