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Organization
WADE MELVIN BANNER D.M.D., INC
Active
Organization
WADE MELVIN BANNER D.M.D., INC
Active
Other names
In Motion Dentists
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WADE MELVIN BANNER D.M.D. (OWNER)
(626) 594-0374
Entity
Organization
Contact information
Practice address
2060 E ROUTE 66 STE 105, GLENDORA, CA 91740-4691
(626) 594-0374
(626) 594-0813
Mailing address
929 W. FOOTHILL BLVD., SUITE A, LA VERNE, CA 91750-3223
(626) 594-0374
(626) 594-0813
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
63601
CA
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
08/26/2014
Last updated
05/28/2024
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