Provider Demographics
NPI:1336162767
Name:PANACEK, EILEEN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:K
Last Name:PANACEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 LATHROP AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405
Mailing Address - Country:US
Mailing Address - Phone:262-632-0719
Mailing Address - Fax:262-632-1007
Practice Address - Street 1:1900 LATHROP AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405
Practice Address - Country:US
Practice Address - Phone:262-632-0719
Practice Address - Fax:262-632-1007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice