Provider Demographics
NPI:1518698000
Name:BANDA, ESMERALDA R (DDS)
Entity Type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:R
Last Name:BANDA
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 1:2601 ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-2916
Mailing Address - Country:US
Mailing Address - Phone:214-229-4444
Mailing Address - Fax:
Practice Address - Street 1:550 S CARRIER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1592
Practice Address - Country:US
Practice Address - Phone:214-677-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice