MEDICARE: MAVERICK BANI, D.D.S., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1124853072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAVERICK BANI, D.D.S., INC.

Provider Business Mailing Address
First Line	:	620 N ARDEN DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-3510
Country	:	US
Telephone Number	:	310-993-0417
Fax Number	:

Provider Business Practice Location Address
First Line	:	709 N LAKE AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-4558
Country	:	US
Telephone Number	:	626-797-8900
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAVERICK BANI
Credential	:	DDS
Telephone Number	:	310-993-0417

Provider Enumeration Date	:	09/02/2024
Last Update Date	:	09/02/2024

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Directions to “MAVERICK BANI, D.D.S., INC. ” Practice Location

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