Provider Demographics
NPI:1083897144
Name:BANKS, KENNETH L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:L
Last Name:BANKS
Suffix:
Gender:M
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:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-0722
Mailing Address - Country:US
Mailing Address - Phone:304-229-2181
Mailing Address - Fax:304-229-2291
Practice Address - Street 1:4325 GERRARDSTOWN ROAD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-0722
Practice Address - Country:US
Practice Address - Phone:304-229-2181
Practice Address - Fax:304-229-2291
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2765122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist