Provider Demographics
NPI:1265641617
Name:BANKHEAD ORTHODONTICS DDS PC
Entity Type:Organization
Organization Name:BANKHEAD ORTHODONTICS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:BANKHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:636-978-8848
Mailing Address - Street 1:2990 HWY K
Mailing Address - Street 2:
Mailing Address - City:OFALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368
Mailing Address - Country:US
Mailing Address - Phone:636-978-8848
Mailing Address - Fax:636-978-0240
Practice Address - Street 1:2990 HWY Y
Practice Address - Street 2:
Practice Address - City:OFALLON
Practice Address - State:MO
Practice Address - Zip Code:63368
Practice Address - Country:US
Practice Address - Phone:636-978-8848
Practice Address - Fax:636-978-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0158761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty