Provider Demographics
NPI:1639270416
Name:PANNELL, BRIAN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
Last Name:PANNELL
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 1:11809 HIGH DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211
Mailing Address - Country:US
Mailing Address - Phone:913-338-1056
Mailing Address - Fax:
Practice Address - Street 1:1010 CARONDELET DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4859
Practice Address - Country:US
Practice Address - Phone:816-941-0000
Practice Address - Fax:816-941-3146
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149791223S0112X
KS60601223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT95741Medicare UPIN
MOB051795AMedicare ID - Type Unspecified