Provider Demographics
NPI:1205028396
Name:BANAKUS, NEIDRE JANELL (DDS)
Entity type:Individual
Prefix:DR
First Name:NEIDRE
Middle Name:JANELL
Last Name:BANAKUS
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:2255 TREELIGHT WAY
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591
Mailing Address - Country:US
Mailing Address - Phone:919-200-0463
Mailing Address - Fax:919-800-3692
Practice Address - Street 1:2255 TREELIGHT WAY
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591
Practice Address - Country:US
Practice Address - Phone:919-200-0463
Practice Address - Fax:919-800-3692
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2025-05-08
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Provider Licenses
StateLicense IDTaxonomies
NC112911223P0221X, 1223P0221X
KY83901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry