Provider Demographics
NPI:1528124583
Name:PAN, MARY (DDS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:PAN
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 1:7000 VILLAGE PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2454
Mailing Address - Country:US
Mailing Address - Phone:925-828-6746
Mailing Address - Fax:925-828-2389
Practice Address - Street 1:7000 VILLAGE PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2454
Practice Address - Country:US
Practice Address - Phone:925-828-6746
Practice Address - Fax:925-828-2389
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA466671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice