Provider Demographics
NPI:1083885073
Name:BANKER DENTAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:BANKER DENTAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-354-1490
Mailing Address - Street 1:105 ELMORA AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1614
Mailing Address - Country:US
Mailing Address - Phone:908-354-1490
Mailing Address - Fax:908-354-6996
Practice Address - Street 1:105 ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1614
Practice Address - Country:US
Practice Address - Phone:908-354-1490
Practice Address - Fax:908-354-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty