Provider Demographics
NPI:1649880881
Name:PANSOY, PATRICK RENAN (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:RENAN
Last Name:PANSOY
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 1:860 SARATOGA AVE APT H305
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2625
Mailing Address - Country:US
Mailing Address - Phone:571-426-4090
Mailing Address - Fax:
Practice Address - Street 1:753 SARATOGA AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2330
Practice Address - Country:US
Practice Address - Phone:408-255-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist