Provider Demographics
NPI:1790191377
Name:ANGUEL PANEV, DDS, PC
Entity Type:Organization
Organization Name:ANGUEL PANEV, DDS, PC
Other - Org Name:GRAND SMILE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGUEL
Authorized Official - Middle Name:HRISTOV
Authorized Official - Last Name:PANEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-218-9494
Mailing Address - Street 1:772 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5395
Mailing Address - Country:US
Mailing Address - Phone:718-218-9494
Mailing Address - Fax:
Practice Address - Street 1:772 GRAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5395
Practice Address - Country:US
Practice Address - Phone:718-218-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty