Provider Demographics
NPI:1962622332
Name:GREG J PANOSSIAN DDS PLLC
Entity type:Organization
Organization Name:GREG J PANOSSIAN DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANOSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-541-4767
Mailing Address - Street 1:5240 MERRICK RD STE 1
Mailing Address - Street 2:
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 STE 1
Practice Address - Street 2:
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:2007-04-26
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051170261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery