Healthcare Provider Details

I. General information

NPI: 1760796338
Provider Name (Legal Business Name): IRIS ANASTASIA PANOS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 SWIFT RD BLDG 606
WEST POINT NY
10996-1942
US

IV. Provider business mailing address

646 SWIFT RD BLDG 606
WEST POINT NY
10996-1942
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-7769
  • Fax:
Mailing address:
  • Phone: 845-938-7769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN1855434
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1855434
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberA058336
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberA058336
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: