MEDICARE: DR. BANA A ANBARI DDS, MSD

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	1223P0300X	Periodontics	30.022360	OH

General Provider Information

NPI Number	:	1720378599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BANA A ANBARI DDS, MSD

Provider Business Mailing Address
First Line	:	31032 LOGAN CT
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-6831
Country	:	US
Telephone Number	:	440-808-8082
Fax Number	:

Provider Business Practice Location Address
First Line	:	24803 DETROIT RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-2553
Country	:	US
Telephone Number	:	440-835-5388
Fax Number	:

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

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	04/14/2011

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