MEDICARE: MR. KENYON THOMAS BANFIELD DMD

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	122300000X	Dentist	6960	AZ

General Provider Information

NPI Number	:	1245366798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENYON THOMAS BANFIELD DMD

Provider Business Mailing Address
First Line	:	570 N CITRUS LANE
Second Line	:
City	:	HIGLEY
State	:	AZ
Zip	:	85236
Country	:	US
Telephone Number	:	480-840-5813
Fax Number	:

Provider Business Practice Location Address
First Line	:	2485 GREAT WESTERN STE E
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314
Country	:	US
Telephone Number	:	928-775-9495
Fax Number	:	928-775-9497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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