Provider Demographics
NPI:1801954730
Name:BANTEL, DAWN ANNE (NMD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ANNE
Last Name:BANTEL
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10490 E. ESCALANTE RD.
Mailing Address - Street 2:MIRASOL
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701
Mailing Address - Country:US
Mailing Address - Phone:520-886-8828
Mailing Address - Fax:520-203-0270
Practice Address - Street 1:MIRASOL INC 10490 E ESCALANTE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-5502
Practice Address - Country:US
Practice Address - Phone:520-886-8828
Practice Address - Fax:520-203-0270
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ01665175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath