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General NPI Number Information
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NPI Number | 1760796338
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Entity Type | Individual
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Provider Name | IRIS ANASTASIA PANOS DMD
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Gender | Female
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 12/18/2021
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Provider Practice Location Address
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Address Line | 646 SWIFT RD BLDG 606
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City | WEST POINT
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State | NY
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Zip | 10996-1942
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Country | US
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Telephone | 845-938-7769
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Fax |
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Provider Business Mailing Address
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Address Line | 646 SWIFT RD BLDG 606
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City | WEST POINT
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State | NY
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Zip | 10996-1942
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Country | US
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Telephone | 845-938-7769
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1855434
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | A058336
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | A058336
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN1855434
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License Number State | MA
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