Provider Demographics
NPI:1912610981
Name:PANLILIO DENTAL PRACTICE CORPORATION
Entity Type:Organization
Organization Name:PANLILIO DENTAL PRACTICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANLILIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:831-224-3924
Mailing Address - Street 1:1249 FREMONT BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-5754
Mailing Address - Country:US
Mailing Address - Phone:831-392-1888
Mailing Address - Fax:831-392-0188
Practice Address - Street 1:1249 FREMONT BLVD STE B
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5754
Practice Address - Country:US
Practice Address - Phone:831-392-1888
Practice Address - Fax:831-392-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty