Provider Demographics
NPI:1114114857
Name:DAVID B BANDA DDS PC
Entity Type:Organization
Organization Name:DAVID B BANDA DDS PC
Other - Org Name:CRANBROOK DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-647-5434
Mailing Address - Street 1:33 BLOOMFIELD HILLS PARKWAY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304
Mailing Address - Country:US
Mailing Address - Phone:248-647-5434
Mailing Address - Fax:248-647-7688
Practice Address - Street 1:33 BLOOMFIELD HILLS PARKWAY
Practice Address - Street 2:SUITE 140
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304
Practice Address - Country:US
Practice Address - Phone:248-647-5434
Practice Address - Fax:248-647-7688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010143801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty