MEDICARE: DR. OLGA CHRISTINE PANAGOS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901601759	MI

General Provider Information

NPI Number	:	1205529641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLGA CHRISTINE PANAGOS DDS

Provider Business Mailing Address
First Line	:	9840 HAGGERTY RD
Second Line	:
City	:	VAN BUREN TWP
State	:	MI
Zip	:	48111-3443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9840 HAGGERTY RD
Second Line	:
City	:	VAN BUREN TWP
State	:	MI
Zip	:	48111-3443
Country	:	US
Telephone Number	:	734-697-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	09/13/2023

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