Provider Demographics
NPI:1275687063
Name:MAJOR-BANKS, ROSCHELLE BONITA (DDS)
Entity Type:Individual
Prefix:
First Name:ROSCHELLE
Middle Name:BONITA
Last Name:MAJOR-BANKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2406
Mailing Address - Country:US
Mailing Address - Phone:317-547-5766
Mailing Address - Fax:317-547-5290
Practice Address - Street 1:2811 E 46TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2406
Practice Address - Country:US
Practice Address - Phone:317-547-5766
Practice Address - Fax:317-547-5290
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120091641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice