MEDICARE: DR. IRIS ANASTASIA PANOS DMD

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	1223G0001X	General Practice Dentistry	DN1855434	MA
2	1223P0300X	Periodontics	A058336	NY
3	171100000X	Acupuncturist	A058336	NY
4	1223P0300X	Periodontics	DN1855434	MA

General Provider Information

NPI Number	:	1760796338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRIS ANASTASIA PANOS DMD

Provider Business Mailing Address
First Line	:	646 SWIFT RD BLDG 606
Second Line	:
City	:	WEST POINT
State	:	NY
Zip	:	10996-1942
Country	:	US
Telephone Number	:	845-938-7769
Fax Number	:

Provider Business Practice Location Address
First Line	:	646 SWIFT RD BLDG 606
Second Line	:
City	:	WEST POINT
State	:	NY
Zip	:	10996-1942
Country	:	US
Telephone Number	:	845-938-7769
Fax Number	:

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

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	12/18/2021

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