Provider Demographics
NPI:1396052759
Name:PANNU, PAWANJEET SINGH
Entity type:Individual
Prefix:
First Name:PAWANJEET
Middle Name:SINGH
Last Name:PANNU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PAWANJEET
Other - Middle Name:
Other - Last Name:SINGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1918 GLEN HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2921
Mailing Address - Country:US
Mailing Address - Phone:718-594-2282
Mailing Address - Fax:
Practice Address - Street 1:1918 GLEN HARBOR DR
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2921
Practice Address - Country:US
Practice Address - Phone:718-594-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA597961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice