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General NPI Number Information
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NPI Number | 1982091153
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Entity Type | Individual
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Provider Name | RICKY PAN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 190 PINE AVE N
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City | OLDSMAR
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State | FL
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Zip | 34677-4629
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Country | US
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Telephone | 813-855-1007
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Fax | 813-855-1009
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Provider Business Mailing Address
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Address Line | 190 PINE AVE N
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City | OLDSMAR
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State | FL
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Zip | 34677-4629
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Country | US
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Telephone | 813-855-1007
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Fax | 813-855-1009
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN21323
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License Number State | FL
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