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General NPI Number Information
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NPI Number | 1639278443
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Entity Type | Individual
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Provider Name | JOHN THOMAS PANZEK DDS
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1205 N COURTENAY PKWY
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-5500
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Country | US
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Telephone | 321-452-0591
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Fax | 321-452-4839
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Provider Business Mailing Address
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Address Line | 290 SHERWOOD AVE
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City | SATELLITE BEACH
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State | FL
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Zip | 32937-3054
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Country | US
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Telephone | 321-452-0591
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Fax | 321-452-4839
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN12033
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License Number State | FL
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