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General NPI Number Information
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NPI Number | 1265563746
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Entity Type | Individual
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Provider Name | GARY LEE PANNABECKER DDS
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 118 HAMBY RD
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City | DOBSON
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State | NC
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Zip | 27017-8471
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Country | US
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Telephone | 336-401-8589
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Fax | 336-401-8599
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Provider Business Mailing Address
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Address Line | PO BOX 760
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City | BROWNING
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State | MT
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Zip | 59417-0760
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Country | US
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Telephone | 406-338-6180
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Fax | 406-338-6184
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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 | 2030
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10583
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License Number State | NC
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