Provider Demographics
NPI:1407217870
Name:PANOSSIAN ORAL SURGERY
Entity type:Organization
Organization Name:PANOSSIAN ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-541-4767
Mailing Address - Street 1:5240 MERRICK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6207
Mailing Address - Country:US
Mailing Address - Phone:516-541-4767
Mailing Address - Fax:516-541-4769
Practice Address - Street 1:5240 MERRICK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6207
Practice Address - Country:US
Practice Address - Phone:516-541-4767
Practice Address - Fax:516-541-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0511701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty