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Organization
BANSTOLA
Active
Organization
BANSTOLA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BASU BANSTOLA DMD (OWNER DENTIST)
(770) 934-1698
Entity
Organization
Contact information
Practice address
2315 BROCKETT RD, TUCKER, GA 30084-4412
(770) 934-1698
Mailing address
PO BOX 2635, TUCKER, GA 30085-2635
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/01/2021
Last updated
12/01/2021
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