MEDICARE: DR. GLENN BANKS DDS

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	1223G0001X	General Practice Dentistry	22493	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518970441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN BANKS DDS

Provider Business Mailing Address
First Line	:	16210 TAHOE DR
Second Line	:
City	:	JERSEY VILLAGE
State	:	TX
Zip	:	77040-1250
Country	:	US
Telephone Number	:	281-606-5820
Fax Number	:

Provider Business Practice Location Address
First Line	:	5438 NORTH FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-4701
Country	:	US
Telephone Number	:	713-697-9100
Fax Number	:

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/07/2012

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