Healthcare Provider Details

I. General information

NPI: 1003971698
Provider Name (Legal Business Name): BRIAN JOSEPH PALANK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 MADDEX DRIVE
SHEPHERDSTOWN WV
25443-1133
US

IV. Provider business mailing address

PO BOX 1133
SHEPHERDSTOWN WV
25443-1133
US

V. Phone/Fax

Practice location:
  • Phone: 304-876-2562
  • Fax:
Mailing address:
  • Phone: 304-876-2562
  • Fax: 304-876-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2501
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: