Provider Demographics
NPI:1740918465
Name:PANOPIO, KATHERINE ROXAS (DDS)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROXAS
Last Name:PANOPIO
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 1:201 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1119
Mailing Address - Country:US
Mailing Address - Phone:650-892-6825
Mailing Address - Fax:
Practice Address - Street 1:4200 CALIFORNIA ST STE 210
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1367
Practice Address - Country:US
Practice Address - Phone:415-668-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist