MEDICARE: SUMEET PANNU DDS INC

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	62076	CA

General Provider Information

NPI Number	:	1285181115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMEET PANNU DDS INC

Provider Business Mailing Address
First Line	:	3040 PARK AVE STE H
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95348-3405
Country	:	US
Telephone Number	:	209-722-7789
Fax Number	:

Provider Business Practice Location Address
First Line	:	3040 PARK AVE STE H
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95348-3405
Country	:	US
Telephone Number	:	209-722-7789
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. SUMEET PANNU
Credential	:	DDDS
Telephone Number	:	408-512-6359

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	09/08/2016

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