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Organization
JEROME A BANNISTER DDS INC
Active
Organization
JEROME A BANNISTER DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LIZBETH CHAVEZ (OFFICE MANAGER)
(619) 428-8682
Entity
Organization
Contact information
Practice address
4370 PALM AVE, STE C, SAN DIEGO, CA 92154-1760
(619) 428-8682
(619) 428-1043
Mailing address
4370 PALM AVE, STE C, SAN DIEGO, CA 92154-1760
(619) 428-8682
(619) 428-1043
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
38253
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B38253 01
MEDI CAL
CA
Enumeration date
10/19/2005
Last updated
08/22/2020
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