Provider Demographics
NPI:1851637144
Name:PANNU, SUMEET
Entity Type:Individual
Prefix:
First Name:SUMEET
Middle Name:
Last Name:PANNU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 PARK AVE SUITE H
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348
Mailing Address - Country:US
Mailing Address - Phone:209-722-7789
Mailing Address - Fax:209-722-7811
Practice Address - Street 1:3040 PARK AVE SUITE H
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348
Practice Address - Country:US
Practice Address - Phone:209-722-7789
Practice Address - Fax:209-722-7811
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62076122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist