Healthcare Provider Details

I. General information

NPI: 1851637144
Provider Name (Legal Business Name): SUMEET PANNU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 FLOYD AVE STE 609
MODESTO CA
95355-9802
US

IV. Provider business mailing address

3020 FLOYD AVE STE 609
MODESTO CA
95355-9802
US

V. Phone/Fax

Practice location:
  • Phone: 209-551-1414
  • Fax: 209-551-1033
Mailing address:
  • Phone: 209-551-1414
  • Fax: 209-551-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: