Provider Demographics
NPI:1528205267
Name:BANKHEAD DDS WARRENTON ORTHODONTICS PC
Entity Type:Organization
Organization Name:BANKHEAD DDS WARRENTON ORTHODONTICS PC
Other - Org Name:WARRENTON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:BANKHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:636-978-8848
Mailing Address - Street 1:511 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-1065
Mailing Address - Country:US
Mailing Address - Phone:636-456-3770
Mailing Address - Fax:636-456-3779
Practice Address - Street 1:511 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-1065
Practice Address - Country:US
Practice Address - Phone:636-456-3770
Practice Address - Fax:636-456-3779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BANKHEAD DDS ORTHODONTICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015876302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization