Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 102455 | CA |
NPI | 1144592064 |
---|---|
Provider Name | Dr. Brooke Ashley Pancer |
First Address | Newport Beach, CA 92660 |
Second Address | Seal Beach, CA 90740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2012 |
Last Update Date | 05/11/2018 |