Healthcare Provider Details

I. General information

NPI: 1396925244
Provider Name (Legal Business Name): BRIAN ROBERT BANFIELD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S LINDSAY RD STE 127
GILBERT AZ
85297-2100
US

IV. Provider business mailing address

3303 S. LINDSAY ROAD, #127
GILBERT AZ
85297
US

V. Phone/Fax

Practice location:
  • Phone: 480-699-2940
  • Fax: 480-699-2941
Mailing address:
  • Phone: 480-699-2940
  • Fax: 480-699-2941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6826
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: