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NPI Code Detail

MEDICARE: DR. CHARLES JOSEPH BANASKY DDS

MEDICARE: DR. CHARLES JOSEPH BANASKY 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
1122300000XDentist22468CA

General Provider Information

NPI Number : 1831285154
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES JOSEPH BANASKY DDS
Provider Business Mailing Address
First Line : 1549 PALOS VERDES DR W
Second Line :
City : PALOS VERDES ESTATES
State : CA
Zip : 90274-1846
Country : US
Telephone Number : 310-378-4646
Fax Number :
Provider Business Practice Location Address
First Line : 1440 W MANCHESTER AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90047-5422
Country : US
Telephone Number : 323-753-1141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 07/08/2007

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