Healthcare Provider Details

I. General information

NPI: 1336158153
Provider Name (Legal Business Name): DIANNE D PANNES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 BROADWAY
NEWPORT RI
02840-2748
US

IV. Provider business mailing address

136 BROADWAY
NEWPORT RI
02840-2748
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-3801
  • Fax:
Mailing address:
  • Phone: 401-846-3801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number03266
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number03266
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: