Healthcare Provider Details

I. General information

NPI: 1770507915
Provider Name (Legal Business Name): LAEL B BANNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 1ST AVE NW STE 8
SEATTLE WA
98117
US

IV. Provider business mailing address

8540 1ST AVE NW STE 8
SEATTLE WA
98117
US

V. Phone/Fax

Practice location:
  • Phone: 206-801-3900
  • Fax: 360-786-1603
Mailing address:
  • Phone: 206-801-3900
  • Fax: 360-786-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00009682
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: