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Organization
SUSAN KAY BANTA DDS MS PA
Active
Organization
SUSAN KAY BANTA DDS MS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN KAY BANTA DDS MS (PRESIDENT)
(910) 772-9770
Entity
Organization
Contact information
Practice address
1611 DOCTORS CIRCLE, WILMINGTON, NC 28401
(910) 772-9770
(910) 772-1553
Mailing address
1611 DOCTORS CIRCLE, WILMINGTON, NC 28401
(910) 772-9770
(910) 772-1553
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
12/19/2006
Last updated
12/17/2007
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