Provider Demographics
NPI:1508939851
Name:BANNOW, RICHARD KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KEVIN
Last Name:BANNOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3017
Mailing Address - Country:US
Mailing Address - Phone:269-372-1042
Mailing Address - Fax:269-372-9962
Practice Address - Street 1:5917 STADIUM DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-3017
Practice Address - Country:US
Practice Address - Phone:269-372-1042
Practice Address - Fax:269-372-9962
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist