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General NPI Number Information
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NPI Number | 1386827707
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Entity Type | Organization
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Legal Business Name | MARC PANA PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 6 HUGHES SUITE 100
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City | IRVINE
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State | CA
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Zip | 92618-2059
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Country | US
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Telephone | 877-358-3915
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Fax | 949-680-1881
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Provider Business Mailing Address
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Address Line | 6 HUGHES SUITE 100
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City | IRVINE
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State | CA
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Zip | 92618-2059
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Country | US
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Telephone | 877-358-3915
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Fax | 949-680-1881
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Authorized Official
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Title or Position | ORTHODONTIST/ PRESIDENT
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Name | DR. MARC PANA
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Credential | D.D.S., M.S.
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Telephone | 310-435-5622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 54184
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License Number State | CA
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