Provider Demographics
NPI:1285767483
Name:PANOSKE, JOSEPH S (DDS SC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:S
Last Name:PANOSKE
Suffix:
Gender:M
Credentials:DDS SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 6TH ST
Mailing Address - Street 2:P.O. BOX 619
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1500
Mailing Address - Country:US
Mailing Address - Phone:608-325-6129
Mailing Address - Fax:608-329-4377
Practice Address - Street 1:2727 6TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1500
Practice Address - Country:US
Practice Address - Phone:608-325-6129
Practice Address - Fax:608-329-4377
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist