Provider Demographics
NPI:1982602736
Name:PANITCH, THOMAS M (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:PANITCH
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 1:20 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3310
Mailing Address - Country:US
Mailing Address - Phone:973-374-9752
Mailing Address - Fax:973-371-9265
Practice Address - Street 1:20 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3310
Practice Address - Country:US
Practice Address - Phone:973-374-9752
Practice Address - Fax:973-371-9265
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
NJ79011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice