Provider Demographics
NPI:1740721307
Name:BANAGA, GERARD (DDS)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:
Last Name:BANAGA
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 1:1155 2ND ST
Mailing Address - Street 2:STE. B
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2285
Mailing Address - Country:US
Mailing Address - Phone:925-516-8793
Mailing Address - Fax:
Practice Address - Street 1:1155 2ND ST
Practice Address - Street 2:STE. B
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2285
Practice Address - Country:US
Practice Address - Phone:925-516-8793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist