Provider Demographics
NPI:1720148786
Name:BANKS, ROBERT JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:BANKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 SUNRISE VALLEY DR.
Mailing Address - Street 2:SUITE 1137
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191
Mailing Address - Country:US
Mailing Address - Phone:703-391-8836
Mailing Address - Fax:703-391-6802
Practice Address - Street 1:11800 SUNRISE VALLEY DR.
Practice Address - Street 2:SUITE 1137
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191
Practice Address - Country:US
Practice Address - Phone:703-391-8836
Practice Address - Fax:703-391-6802
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007772208D00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice