Healthcare Provider Details

I. General information

NPI: 1972622165
Provider Name (Legal Business Name): MICHELE M BANKS AP RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 04/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 N 15TH AVE
PHOENIX AZ
85007-2402
US

IV. Provider business mailing address

5201 E GRANDVIEW RD
SCOTTSDALE AZ
85254-1134
US

V. Phone/Fax

Practice location:
  • Phone: 602-971-6535
  • Fax:
Mailing address:
  • Phone: 602-971-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH1476
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: