William Lee Panneck, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

AR2423 Issued in AR

Practice address

1803 Woodsprings Rd
Jonesboro, AR 72401-0903

Phone

(870) 932-8488

Fax

(870) 932-5717

NPI assigned

Nov 9, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619047321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 WOOD CV",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724015701",
            "telephone_number": "870-935-7958",
            "fax_number": "870-932-5717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 WOODSPRINGS RD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724010903",
            "telephone_number": "870-932-8488",
            "fax_number": "870-932-5717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANNECK",
        "first_name": "WILLIAM",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "AR2423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-BLUE ADVANTAGE",
            "identifier": "562235",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - FEDERAL",
            "identifier": "58820",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• General Practice Dentistry in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.