Provider Demographics
NPI:1881043792
Name:MICHAEL K. BAN, DMD
Entity type:Organization
Organization Name:MICHAEL K. BAN, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-367-3020
Mailing Address - Street 1:4725 MCKNIGHT RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3414
Mailing Address - Country:US
Mailing Address - Phone:412-367-3020
Mailing Address - Fax:412-367-5940
Practice Address - Street 1:4725 MCKNIGHT RD
Practice Address - Street 2:SUITE 209
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3414
Practice Address - Country:US
Practice Address - Phone:412-367-3020
Practice Address - Fax:412-367-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022496L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008772510002Medicaid
PAT30094Medicare UPIN