Provider Demographics
NPI:1104279686
Name:PANAG, SUKHMAN (DDS)
Entity type:Individual
Prefix:
First Name:SUKHMAN
Middle Name:
Last Name:PANAG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 SAGE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-7918
Mailing Address - Country:US
Mailing Address - Phone:760-520-3494
Mailing Address - Fax:
Practice Address - Street 1:1340 W VALLEY PKWY STE 105E
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-2135
Practice Address - Country:US
Practice Address - Phone:760-747-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS100356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist