Provider Demographics
NPI:1780694836
Name:PANAGIOTU, MATTHEW W (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:PANAGIOTU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-3208
Mailing Address - Country:US
Mailing Address - Phone:508-754-9825
Mailing Address - Fax:508-754-9831
Practice Address - Street 1:144 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-3208
Practice Address - Country:US
Practice Address - Phone:508-754-9825
Practice Address - Fax:508-754-9831
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA99171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0228559Medicaid