Healthcare Provider Details

I. General information

NPI: 1003283326
Provider Name (Legal Business Name): PANAGIOTIS DRAGONAS D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2715
US

IV. Provider business mailing address

611 OKEEFE AVE APT 2N7
NEW ORLEANS LA
70113-1969
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-8278
  • Fax:
Mailing address:
  • Phone: 312-646-8295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6897
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: