Provider Demographics
NPI:1568440642
Name:BANNISTER, SHARON R (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:R
Last Name:BANNISTER
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 CENTURY RNCH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4939
Mailing Address - Country:US
Mailing Address - Phone:210-292-7269
Mailing Address - Fax:
Practice Address - Street 1:2200 BERQUIST DRIVE, SUITE 1
Practice Address - Street 2:ATTN: CREDENTIALS (CMC)
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-5300
Practice Address - Country:US
Practice Address - Phone:210-292-7269
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300198651223P0300X
MD117181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0300XDental ProvidersDentistPeriodontics