Provider Demographics
NPI:1720378599
Name:ANBARI, BANA A (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:BANA
Middle Name:A
Last Name:ANBARI
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31032 LOGAN CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6831
Mailing Address - Country:US
Mailing Address - Phone:440-808-8082
Mailing Address - Fax:
Practice Address - Street 1:24803 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2553
Practice Address - Country:US
Practice Address - Phone:440-835-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0223601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics