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General NPI Number Information
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NPI Number | 1811787245
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Entity Type | Individual
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Provider Name | JESSICA L BANJANY
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Gender |
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 1544 OXBOW DR STE 230
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City | MONTROSE
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State | CO
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Zip | 81401-5189
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Country | US
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Telephone | 970-240-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 515 W 5TH AVE APT 434
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City | COLUMBUS
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State | OH
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Zip | 43201-0115
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Country | US
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Telephone | 732-343-0180
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 00206287
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License Number State | CO
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