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General NPI Number Information
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NPI Number | 1073727848
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Entity Type | Organization
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Legal Business Name | DR. PANESAR
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 207 MAIN ST
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City | FORT FAIRFIELD
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State | ME
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Zip | 04742-1120
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Country | US
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Telephone | 207-473-7723
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Fax |
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Provider Business Mailing Address
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Address Line | 207 MAIN ST
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City | FORT FAIRFIELD
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State | ME
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Zip | 04742-1120
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Country | US
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Telephone | 207-473-7723
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | MRS. PALWINDER KAUR PANESAR
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Credential | DDS
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Telephone | 207-473-7723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3510
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License Number State | ME
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