Provider Demographics
NPI:1689695413
Name:BANAS, EDWARD JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JAMES
Last Name:BANAS
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 1:2113 GOVERNMENT ST
Mailing Address - Street 2:GOVERNMENT PLACE SUITE K-1
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3954
Mailing Address - Country:US
Mailing Address - Phone:228-826-3811
Mailing Address - Fax:228-826-3813
Practice Address - Street 1:2113 GOVERNMENT ST
Practice Address - Street 2:GOVERNMENT PLACE SUITE K-1
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3954
Practice Address - Country:US
Practice Address - Phone:228-826-3811
Practice Address - Fax:228-826-3813
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2726122300000X
GADN013268122300000X
NY036708122300000X
MS3059981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist