Provider Demographics
NPI:1073602652
Name:BANTA, GILDA C (DDS)
Entity Type:Individual
Prefix:DR
First Name:GILDA
Middle Name:C
Last Name:BANTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6831 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2938
Mailing Address - Country:US
Mailing Address - Phone:714-893-4409
Mailing Address - Fax:
Practice Address - Street 1:4900 EDINGER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-2301
Practice Address - Country:US
Practice Address - Phone:714-846-4411
Practice Address - Fax:714-846-4061
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice