Healthcare Provider Details

I. General information

NPI: 1710687793
Provider Name (Legal Business Name): SUMER PANESAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2358 S COUNTY TRL
EAST GREENWICH RI
02818-1583
US

IV. Provider business mailing address

2358 S COUNTY TRL
EAST GREENWICH RI
02818-1583
US

V. Phone/Fax

Practice location:
  • Phone: 401-889-2638
  • Fax:
Mailing address:
  • Phone: 401-889-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12013632A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12013632A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: