Provider Demographics
NPI:1992030548
Name:JASON A. BANKS, D.D.S., P.A.
Entity Type:Organization
Organization Name:JASON A. BANKS, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-331-2304
Mailing Address - Street 1:103 TANGLEWOOD PKWY N
Mailing Address - Street 2:SUITE K
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9630
Mailing Address - Country:US
Mailing Address - Phone:252-331-2304
Mailing Address - Fax:
Practice Address - Street 1:103 TANGLEWOOD PKWY N
Practice Address - Street 2:SUITE K
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-9630
Practice Address - Country:US
Practice Address - Phone:252-331-2304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty