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General NPI Number Information
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NPI Number | 1932373636
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Entity Type | Organization
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Legal Business Name | J. MICHAEL PANCZYSZYN, D.D.S., PA
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 938 BRIDGEWATER DR UNIT 3B
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City | PORT ORANGE
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State | FL
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Zip | 32129-6108
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Country | US
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Telephone | 386-756-3728
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Fax |
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Provider Business Mailing Address
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Address Line | 938 BRIDGEWATER DR UNIT 3B
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City | PORT ORANGE
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State | FL
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Zip | 32129-6108
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Country | US
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Telephone | 386-756-3728
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | J. MICHAEL PANCZYSZYN
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Credential | D.D.S.
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Telephone | 386-756-3728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN0009950
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License Number State | FL
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