# DR. BRENT S. BANNER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437329356
- **Authorized official:** DR. BRENT BANNER (OWNER)
- **Authorized official phone:** (208) 678-5597

## Contact information

- **Practice address:** 1010 E MAIN ST, BURLEY, ID 83318-2045
- **Practice address phone:** (208) 678-5597
- **Mailing address:** 1010 EAST MAIN, BURLEY, ID 83318-2045

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3028 | ID | Yes |

## Other

- **Enumeration date:** 03/06/2008
- **Last updated:** 03/06/2008