Healthcare Provider Details

I. General information

NPI: 1083897144
Provider Name (Legal Business Name): KENNETH L BANKS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 GERRARDSTOWN ROAD
INWOOD WV
25428-0722
US

IV. Provider business mailing address

PO BOX 722
INWOOD WV
25428-0722
US

V. Phone/Fax

Practice location:
  • Phone: 304-229-2181
  • Fax: 304-229-2291
Mailing address:
  • Phone: 304-229-2181
  • Fax: 304-229-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2765
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: