Provider Demographics
NPI:1396788246
Name:BANAS, KENNETH RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RICHARD
Last Name:BANAS
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 1:3615 SENECA ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3444
Mailing Address - Country:US
Mailing Address - Phone:716-674-0924
Mailing Address - Fax:716-675-4774
Practice Address - Street 1:3615 SENECA ST
Practice Address - Street 2:SUITE N
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3444
Practice Address - Country:US
Practice Address - Phone:716-674-0924
Practice Address - Fax:716-675-4774
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038341-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00834684Medicaid