MEDICARE: DR. EDWARD JAMES BANAS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DD2726	NM
2	122300000X	Dentist	DN013268	GA
3	122300000X	Dentist	036708	NY
4	1223G0001X	General Practice Dentistry	305998	MS

General Provider Information

NPI Number	:	1689695413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD JAMES BANAS DDS

Provider Business Mailing Address
First Line	:	2113 GOVERNMENT ST
Second Line	:	GOVERNMENT PLACE SUITE K-1
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3954
Country	:	US
Telephone Number	:	228-826-3811
Fax Number	:	228-826-3813

Provider Business Practice Location Address
First Line	:	2113 GOVERNMENT ST
Second Line	:	GOVERNMENT PLACE SUITE K-1
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3954
Country	:	US
Telephone Number	:	228-826-3811
Fax Number	:	228-826-3813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/13/2011

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