Provider Demographics
NPI:1679049878
Name:BANKS PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:BANKS PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-699-8082
Mailing Address - Street 1:2500 S POWER RD STE 128
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-6689
Mailing Address - Country:US
Mailing Address - Phone:480-699-8082
Mailing Address - Fax:
Practice Address - Street 1:2500 S POWER RD STE 128
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-6689
Practice Address - Country:US
Practice Address - Phone:480-699-8082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty