MEDICARE: DR. MICHAEL PANTOS D.M.D

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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	10878	MD

General Provider Information

NPI Number	:	1487715132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL PANTOS D.M.D

Provider Business Mailing Address
First Line	:	10282 BALTIMORE NATIONAL PIKE
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-3670
Country	:	US
Telephone Number	:	410-480-0426
Fax Number	:	410-203-9176

Provider Business Practice Location Address
First Line	:	10282 BALTIMORE NATIONAL PIKE
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-3670
Country	:	US
Telephone Number	:	410-480-0426
Fax Number	:	410-203-9176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	06/08/2011

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