Provider Demographics
NPI:1265563746
Name:PANNABECKER, GARY LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:PANNABECKER
Suffix:
Gender:M
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:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-0760
Mailing Address - Country:US
Mailing Address - Phone:406-338-6180
Mailing Address - Fax:406-338-6184
Practice Address - Street 1:118 HAMBY RD
Practice Address - Street 2:
Practice Address - City:DOBSON
Practice Address - State:NC
Practice Address - Zip Code:27017-8471
Practice Address - Country:US
Practice Address - Phone:336-401-8589
Practice Address - Fax:336-401-8599
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2030122300000X
NC105831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist