Individual provider Active NPI

Sukhminder Singh Pannu, DDS

  • Dentist
  • Vestal, NY
National Provider Identifier
1417939786
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
048923 Issued in NY
Practice address
4501 Vestal Pkwy E
Vestal, NY 13850-3565
Phone
(607) 777-1340
Fax
(607) 777-1345
NPI assigned
Nov 14, 2005
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 048923 NY Primary

Addresses

Primary practice location

4501 Vestal Pkwy E
Vestal, NY 13850-3565

Mailing address

4501 Vestal Pkwy E
Vestal, NY 13850-3565
Phone (607) 777-1340

Other identifiers 1

IdentifierTypeStateIssuer
02121915MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
New York Dental LLC Dentist Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1417939786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 VESTAL PKWY E",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138503565",
            "telephone_number": "607-777-1340",
            "fax_number": "607-777-1345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 VESTAL PKWY E",
            "city": "VESTAL",
            "state": "NY",
            "postal_code": "138503565",
            "telephone_number": "607-777-1340",
            "fax_number": "607-777-1345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANNU",
        "first_name": "SUKHMINDER",
        "middle_name": "SINGH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "048923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02121915",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vestal, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.