Provider Demographics
NPI:1770033698
Name:BANDA, DENISE (DDS)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:BANDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 E 213TH ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2132
Mailing Address - Country:US
Mailing Address - Phone:310-350-6199
Mailing Address - Fax:
Practice Address - Street 1:4531 PHILADELPHIA ST STE B107
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2249
Practice Address - Country:US
Practice Address - Phone:310-350-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1008231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice