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General NPI Number Information
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NPI Number | 1194844571
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Entity Type | Individual
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Provider Name | BARRY JOHN PANNING D.D.S
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3001 HARBOR LN N SUITE 100
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City | PLYMOUTH
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State | MN
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Zip | 55447-5102
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Country | US
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Telephone | 763-553-0451
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Fax | 763-559-3425
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Provider Business Mailing Address
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Address Line | 3001 HARBOR LN N SUITE 100
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City | PLYMOUTH
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State | MN
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Zip | 55447-5102
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Country | US
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Telephone | 763-553-0451
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Fax | 763-559-3425
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | D11435
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License Number State | MN
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