Provider Demographics
NPI:1891234050
Name:PANESAR, KANVAR (DDS, MS, MD)
Entity Type:Individual
Prefix:
First Name:KANVAR
Middle Name:
Last Name:PANESAR
Suffix:
Gender:M
Credentials:DDS, MS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 7TH AVE S RM 406
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-2005
Mailing Address - Country:US
Mailing Address - Phone:206-543-5860
Mailing Address - Fax:
Practice Address - Street 1:1919 7TH AVE S RM 406
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2005
Practice Address - Country:US
Practice Address - Phone:206-543-5860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60853764122300000X
390200000X
AL46766208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program