Provider Demographics
NPI:1659764983
Name:ANNE G BANTA DDS INC
Entity Type:Organization
Organization Name:ANNE G BANTA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BANTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-574-2444
Mailing Address - Street 1:5680 BRIDGETOWN RD
Mailing Address - Street 2:STE B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-4383
Mailing Address - Country:US
Mailing Address - Phone:513-574-2444
Mailing Address - Fax:
Practice Address - Street 1:5680 BRIDGETOWN RD
Practice Address - Street 2:STE B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-4383
Practice Address - Country:US
Practice Address - Phone:513-574-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.017972261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental