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NPI Code Detail

MEDICARE: DR. JIANA P PANOS D.D.S

MEDICARE: DR. JIANA P PANOS D.D.S
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
11223G0001XGeneral Practice Dentistry019.027686IL

General Provider Information

NPI Number : 1568627776
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JIANA P PANOS D.D.S
Provider Business Mailing Address
First Line : 1583 HUNTINGTON DR
Second Line :
City : CALUMET CITY
State : IL
Zip : 60409-5440
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1583 HUNTINGTON DR
Second Line :
City : CALUMET CITY
State : IL
Zip : 60409-5440
Country : US
Telephone Number : 708-818-8090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2008
Last Update Date : 05/18/2016

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