Healthcare Provider Details

I. General information

NPI: 1366368375
Provider Name (Legal Business Name): HARKAMAL SINGH PANNU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 ROSEVILLE PKWY
ROSEVILLE CA
95678-3535
US

IV. Provider business mailing address

3620 DUCKHORN DR APT 2005
SACRAMENTO CA
95834-1279
US

V. Phone/Fax

Practice location:
  • Phone: 530-301-9312
  • Fax:
Mailing address:
  • Phone: 916-475-8442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113204
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: