Provider Demographics
NPI:1699205344
Name:BANKS DENTAL GROUP INC
Entity Type:Organization
Organization Name:BANKS DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-651-8700
Mailing Address - Street 1:8244 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-4660
Mailing Address - Country:US
Mailing Address - Phone:773-651-8700
Mailing Address - Fax:773-651-8711
Practice Address - Street 1:8244 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-4660
Practice Address - Country:US
Practice Address - Phone:773-651-8700
Practice Address - Fax:773-651-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026355122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003056342Medicaid