Provider Demographics
NPI:1982663928
Name:PANICO, WILLIAM H (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:PANICO
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 1:4 OSLO AVE
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242
Mailing Address - Country:US
Mailing Address - Phone:609-886-2277
Mailing Address - Fax:609-886-2249
Practice Address - Street 1:4 OSLO AVE
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242
Practice Address - Country:US
Practice Address - Phone:609-886-2277
Practice Address - Fax:609-886-2249
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ21600122300000X
NJ220I021600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist