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NPI Code Detail

MEDICARE: PAN DENTAL PLLC

MEDICARE: PAN DENTAL PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1124831078
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAN DENTAL PLLC
Provider Business Mailing Address
First Line : 1580 ELMWOOD AVE STE 10
Second Line :
City : ROCHESTER
State : NY
Zip : 14620-3620
Country : US
Telephone Number : 585-271-1229
Fax Number :
Provider Business Practice Location Address
First Line : 1580 ELMWOOD AVE STE 10
Second Line :
City : ROCHESTER
State : NY
Zip : 14620-3620
Country : US
Telephone Number : 585-271-1229
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. KENNY PAN
Credential : DDS
Telephone Number : 646-267-9419
Provider Enumeration Date : 01/27/2025
Last Update Date : 04/07/2026

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