Provider Demographics
NPI:1326059130
Name:BANNISTER, DENISE CANTU (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:CANTU
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 W CAMPBELL RD
Mailing Address - Street 2:STE. 410
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3465
Mailing Address - Country:US
Mailing Address - Phone:972-498-8670
Mailing Address - Fax:972-498-8676
Practice Address - Street 1:403 W CAMPBELL RD
Practice Address - Street 2:STE. 410
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3465
Practice Address - Country:US
Practice Address - Phone:972-498-8670
Practice Address - Fax:972-498-8676
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine