MEDICARE: BRIAN ROBERT 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	1223E0200X	Endodontics	6826	AZ

General Provider Information

NPI Number	:	1396925244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN ROBERT BANFIELD DMD

Provider Business Mailing Address
First Line	:	3303 S. LINDSAY ROAD, #127
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297
Country	:	US
Telephone Number	:	480-699-2940
Fax Number	:	480-699-2941

Provider Business Practice Location Address
First Line	:	3303 S LINDSAY RD STE 127
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-2100
Country	:	US
Telephone Number	:	480-699-2940
Fax Number	:	480-699-2941

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

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	11/08/2007

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