Provider Demographics
NPI:1447882725
Name:BANNER DENTAL
Entity type:Organization
Organization Name:BANNER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MEMBER LLC
Authorized Official - Prefix:
Authorized Official - First Name:LAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-801-3900
Mailing Address - Street 1:8540 1ST AVE NW STE. 8
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117
Mailing Address - Country:US
Mailing Address - Phone:206-801-3900
Mailing Address - Fax:206-902-9877
Practice Address - Street 1:8540 1ST AVE NW STE. 8
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117
Practice Address - Country:US
Practice Address - Phone:206-801-3900
Practice Address - Fax:206-902-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty