Provider Demographics
NPI:1578239430
Name:BANO, KRIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:
Last Name:BANO
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 1:8613 TOZER CT APT 5
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4831
Mailing Address - Country:US
Mailing Address - Phone:980-226-2239
Mailing Address - Fax:
Practice Address - Street 1:664 E MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MI
Practice Address - Zip Code:49032-8515
Practice Address - Country:US
Practice Address - Phone:269-467-9325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016008491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice