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Organization
MICHAEL BANAWIS DDS PROFESSIONAL CORPORATION
Active
Organization
MICHAEL BANAWIS DDS PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL B BANAWIS DDS (DENTIST)
(626) 357-9801
Entity
Organization
Contact information
Practice address
1745 HUNTINGTON DR, DUARTE, CA 91010-2551
(626) 357-9801
(626) 358-1706
Mailing address
1745 HUNTINGTON DR, DUARTE, CA 91010-2551
(626) 357-9801
(626) 358-1706
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
49278
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
523009
DENTICAL
CA
Enumeration date
01/16/2007
Last updated
07/20/2016
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