Healthcare Provider Details

I. General information

NPI: 1467021394
Provider Name (Legal Business Name): PARASKEVI PANOUSIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 TEACO RD
KENNETT MO
63857-3236
US

IV. Provider business mailing address

215 TEACO RD
KENNETT MO
63857-3236
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-5936
  • Fax: 573-559-3006
Mailing address:
  • Phone: 573-888-5936
  • Fax: 573-559-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2021019568
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: