Provider Demographics
NPI:1659672442
Name:PANOS, ADAM ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:ANDREW
Last Name:PANOS
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 1:833 N SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:TX
Mailing Address - Zip Code:78629-3506
Mailing Address - Country:US
Mailing Address - Phone:830-672-2821
Mailing Address - Fax:830-672-1122
Practice Address - Street 1:833 N SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:TX
Practice Address - Zip Code:78629-3506
Practice Address - Country:US
Practice Address - Phone:830-672-2821
Practice Address - Fax:830-672-1122
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist