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General NPI Number Information
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NPI Number | 1710169149
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Entity Type | Organization
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Legal Business Name | BINGHAMTON DENTAL ,LLC
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 186 ROBINSON ST
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City | BINGHAMTON
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State | NY
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Zip | 13904-1642
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Country | US
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Telephone | 607-722-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 186 ROBINSON ST
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City | BINGHAMTON
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State | NY
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Zip | 13904-1642
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Country | US
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Telephone | 607-722-5555
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SUKHMINDER PANNU
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Credential | D.D.S.
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Telephone | 607-777-1340
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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 | 048923
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License Number State | NY
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