Healthcare Provider Details

I. General information

NPI: 1073621884
Provider Name (Legal Business Name): JOHN KEITH PANNELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S WHITE OAK RD
WHITE OAK TX
75693
US

IV. Provider business mailing address

601 S WHITE OAK RD
WHITE OAK TX
75693
US

V. Phone/Fax

Practice location:
  • Phone: 903-297-0712
  • Fax: 903-759-9056
Mailing address:
  • Phone: 903-297-0712
  • Fax: 903-759-9056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13215
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: