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General NPI Number Information
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NPI Number | 1164972923
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Entity Type | Organization
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Legal Business Name | BANKS FAMILY DENTISTRY
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 2095 20TH AVE
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City | HALEYVILLE
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State | AL
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Zip | 35565-2136
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Country | US
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Telephone | 205-486-8601
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Fax |
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Provider Business Mailing Address
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Address Line | 2095 20TH AVE
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City | HALEYVILLE
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State | AL
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Zip | 35565-2136
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Country | US
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Telephone | 205-486-8601
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES H BANKS JR.
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Credential |
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Telephone | 205-486-8601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6238
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4826
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License Number State | AL
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