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NPI Code Detail

MEDICARE: DR. FOTINOS PANAGAKOS D.M.D

MEDICARE: DR. FOTINOS PANAGAKOS D.M.D
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
11223G0001XGeneral Practice DentistryDI18552NJ

General Provider Information

NPI Number : 1780006130
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FOTINOS PANAGAKOS D.M.D
Provider Business Mailing Address
First Line : 909 RIVER RD
Second Line :
City : PISCATAWAY
State : NJ
Zip : 08854-5503
Country : US
Telephone Number : 908-499-1332
Fax Number :
Provider Business Practice Location Address
First Line : 200 UNIVERSITY PKWY # 102
Second Line :
City : YAKIMA
State : WA
Zip : 98901-9539
Country : US
Telephone Number : 908-499-1332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2014
Last Update Date : 08/31/2025

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