Provider Demographics
NPI:1447439716
Name:GEORGE D BANKHEAD DDS MS PC
Entity type:Organization
Organization Name:GEORGE D BANKHEAD DDS MS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:314-843-5553
Mailing Address - Street 1:3890 S LINDBERGH BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SUNSET HILLS
Mailing Address - State:MO
Mailing Address - Zip Code:63127
Mailing Address - Country:US
Mailing Address - Phone:314-843-5553
Mailing Address - Fax:314-849-6764
Practice Address - Street 1:3890 S LINDBERGH BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:SUNSET HILLS
Practice Address - State:MO
Practice Address - Zip Code:63127
Practice Address - Country:US
Practice Address - Phone:314-843-5553
Practice Address - Fax:314-849-6764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0155761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty