Provider Demographics
NPI:1760796338
Name:PANOS, IRIS ANASTASIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:ANASTASIA
Last Name:PANOS
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 1:646 SWIFT RD BLDG 606
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1942
Mailing Address - Country:US
Mailing Address - Phone:845-938-7769
Mailing Address - Fax:
Practice Address - Street 1:646 SWIFT RD BLDG 606
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1942
Practice Address - Country:US
Practice Address - Phone:845-938-7769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18554341223G0001X, 1223P0300X
NYA0583361223P0300X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice
No171100000XOther Service ProvidersAcupuncturist