Provider Demographics
NPI:1881946333
Name:PANCKO, NANCY KATE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:KATE
Last Name:PANCKO
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 5C
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1392
Mailing Address - Country:US
Mailing Address - Phone:302-658-7354
Mailing Address - Fax:
Practice Address - Street 1:2300 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 5C
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1392
Practice Address - Country:US
Practice Address - Phone:302-658-7354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DJ023677001223X0400X
DEG1-00013561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics