Provider Demographics
NPI:1508290446
Name:BANKER, MELISSA DANIELLE (DDS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DANIELLE
Last Name:BANKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DANIELLE
Other - Last Name:BANKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5005 N. PIEDRAS
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-3303
Mailing Address - Fax:
Practice Address - Street 1:201 BARTLETT DR STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-584-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist