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General NPI Number Information
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NPI Number | 1396189114
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Entity Type | Organization
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Legal Business Name | ANTHONY S. PAN, D.M.D., INC.
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 9328 GARVEY AVE SUITE A
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City | SOUTH EL MONTE
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State | CA
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Zip | 91733-4602
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Country | US
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Telephone | 626-350-0588
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Fax | 626-350-0989
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Provider Business Mailing Address
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Address Line | 9328 GARVEY AVE SUITE A
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City | SOUTH EL MONTE
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State | CA
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Zip | 91733-4602
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Country | US
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Telephone | 626-350-0588
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Fax | 626-350-0989
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTHONY SUNG-EN PAN
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Credential | D.M.D.
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Telephone | 626-350-0588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 59548
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License Number State | CA
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