Mandeep Kaur Pannu

Primary specialty

DentistTaxonomy code 122300000X

License

30.027057 Issued in OH

Practice address

9608 Kenwood Rd
Blue Ash, OH 45242-6129

Phone

(513) 791-2009

NPI assigned

Aug 24, 2020

Last updated

Nov 17, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Evergreen Smiles Inc

  dba Evergreen Smiles

  • General Practice Dentistry
  • West Chester, OH
  • NPI 1699540682
  NPD Authorized official
• Merit Dental of Ohio - Nouneh, Inc

  dba Merit Dental

  • Dentist
  • Cincinnati, OH
  • NPI 1932928942
  NPD

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

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1912510645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4379 LEGACY GREENS DR",
            "city": "BATAVIA",
            "state": "OH",
            "postal_code": "451037109",
            "telephone_number": "203-703-2762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9608 KENWOOD RD",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452426129",
            "telephone_number": "513-791-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANNU",
        "first_name": "MANDEEP",
        "middle_name": "KAUR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-24",
        "last_updated": "2023-11-17",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.027057",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901600575",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eugene Paik, MD
• Jeremy Michael Palmer, PA-C
• Luella A Palo
• Pandora S9 Inc
• Pandora S9 Inc (Preventx)
• Chance Parker-Ray, LCSW/LISW
• Lee Parrish, OTR/L
• Sholly Parvis, RN, IBCLC
• Passport Health Holdings, LLC (Passport Health)
• Pathfinders Counseling, LLC

• Dentist in Blue Ash, OH
• Providers in Blue Ash, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.