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Organization
DENTAL CORPORATION OF WADE MELVIN BANNER DMD INC
Active
Organization
DENTAL CORPORATION OF WADE MELVIN BANNER DMD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WADE BANNER DMD (OWNER)
(909) 973-0099
Entity
Organization
Contact information
Practice address
929 FOOTHILL BLVD STE B, LA VERNE, CA 91750-3223
(909) 973-0099
Mailing address
929 FOOTHILL BLVD STE B, LA VERNE, CA 91750-3223
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/02/2022
Last updated
12/02/2022
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