Provider Demographics
NPI:1821718222
Name:BANISTER, WILLIAM BENTLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BENTLEY
Last Name:BANISTER
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 1:1805 DUKE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3131
Mailing Address - Country:US
Mailing Address - Phone:479-530-1099
Mailing Address - Fax:
Practice Address - Street 1:5701 PRESIDENT GEORGE BUSH HWY STE 140
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3694
Practice Address - Country:US
Practice Address - Phone:214-703-0703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX389241223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice