Provider Demographics
NPI:1447501267
Name:NACY, BAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BAN
Middle Name:
Last Name:NACY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BAN
Other - Middle Name:FARID
Other - Last Name:NACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:55 FRUIT ST
Mailing Address - Street 2:1201 WARREN
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:617-724-0413
Mailing Address - Fax:617-726-2814
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:1201 WARREN
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-0413
Practice Address - Fax:617-726-2814
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025128001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice