Provider Demographics
NPI:1831318351
Name:PANOPIO, ELEAZAR AZUCENA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELEAZAR
Middle Name:AZUCENA
Last Name:PANOPIO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 KING PLZ
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4450
Mailing Address - Country:US
Mailing Address - Phone:650-878-8211
Mailing Address - Fax:650-878-0180
Practice Address - Street 1:980 KING PLZ
Practice Address - Street 2:SUITE 3
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4450
Practice Address - Country:US
Practice Address - Phone:650-878-8211
Practice Address - Fax:650-878-0180
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA504283Medicare ID - Type Unspecified