Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 3806-015 | WI |
NPI | 1407057441 |
---|---|
Provider Name | Dr. George Chris Panos |
First Address | Hartland, WI 53029 |
Second Address | Hartland, WI 53029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 08/07/2007 |