Healthcare Provider Details

I. General information

NPI: 1265563746
Provider Name (Legal Business Name): GARY LEE PANNABECKER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 HAMBY RD
DOBSON NC
27017-8471
US

IV. Provider business mailing address

PO BOX 760
BROWNING MT
59417-0760
US

V. Phone/Fax

Practice location:
  • Phone: 336-401-8589
  • Fax: 336-401-8599
Mailing address:
  • Phone: 406-338-6180
  • Fax: 406-338-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2030
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10583
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: