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General NPI Number Information
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NPI Number | 1184782864
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Entity Type | Organization
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Legal Business Name | DENTAL OFFICE OF DAWN PAN
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8060 SANTA TERESA BL 120
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City | GILROY
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State | CA
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Zip | 95020
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Country | US
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Telephone | 408-246-8899
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Fax | 408-847-0008
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Provider Business Mailing Address
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Address Line | 8060 SANTA TERESA BL 120
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City | GILROY
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State | CA
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Zip | 95020
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Country | US
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Telephone | 408-246-8899
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Fax | 408-847-0008
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. DAWN PAN
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Credential | DDS
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Telephone | 408-246-8899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 45306
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License Number State | CA
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