Provider Demographics
NPI:1770742058
Name:PANOSSIAN, GREG J (DDS)
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:J
Last Name:PANOSSIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5240 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6207
Mailing Address - Country:US
Mailing Address - Phone:516-541-4767
Mailing Address - Fax:516-541-4769
Practice Address - Street 1:5240 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6207
Practice Address - Country:US
Practice Address - Phone:516-541-4767
Practice Address - Fax:516-541-4769
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0511701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery