Provider Demographics
NPI:1235547175
Name:JEAN-PAUL BANH, DDS, PLLC
Entity Type:Organization
Organization Name:JEAN-PAUL BANH, DDS, PLLC
Other - Org Name:PACIFIC NW DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BANH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-397-4030
Mailing Address - Street 1:110 D ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5528
Mailing Address - Country:US
Mailing Address - Phone:253-397-4030
Mailing Address - Fax:
Practice Address - Street 1:110 D ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5528
Practice Address - Country:US
Practice Address - Phone:253-397-4030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE604758031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty