Provider Demographics
NPI:1932518206
Name:MPANTAS, PETER PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:PAUL
Last Name:MPANTAS
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 1:2641 42ND AVE SW
Mailing Address - Street 2:APT 317
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4901
Mailing Address - Country:US
Mailing Address - Phone:516-984-9129
Mailing Address - Fax:
Practice Address - Street 1:2641 42ND AVE SW
Practice Address - Street 2:APT 317
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4901
Practice Address - Country:US
Practice Address - Phone:516-984-9129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60466844122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist