Provider Demographics
NPI:1700219433
Name:SHERWIN PANEM DDS DENTAL CORPORATION
Entity Type:Organization
Organization Name:SHERWIN PANEM DDS DENTAL CORPORATION
Other - Org Name:PALLADIUM DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERWIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-865-4501
Mailing Address - Street 1:729 SUNRISE AVE STE 615
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4548
Mailing Address - Country:US
Mailing Address - Phone:916-865-4501
Mailing Address - Fax:
Practice Address - Street 1:729 SUNRISE AVE STE 615
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4548
Practice Address - Country:US
Practice Address - Phone:916-865-4501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty