Provider Demographics
NPI:1043368517
Name:PANA, MARC (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:PANA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 E GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4122
Mailing Address - Country:US
Mailing Address - Phone:323-587-0738
Mailing Address - Fax:323-584-2596
Practice Address - Street 1:2626 E GAGE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4122
Practice Address - Country:US
Practice Address - Phone:323-587-0738
Practice Address - Fax:323-584-2596
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics