# THOMAS M. BANTA, D.D.S., PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Thomas M. Banta, D.D.S., PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790409092
- **Authorized official:** THOMAS M. BANTA (OWNER)
- **Authorized official phone:** (260) 726-7822

## Contact information

- **Practice address:** 1413 W VOTAW ST, PORTLAND, IN 47371-9501
- **Practice address phone:** (260) 726-7822
- **Mailing address:** 1413 W VOTAW ST, PORTLAND, IN 47371-9501
- **Mailing address phone:** (260) 726-7822

## Taxonomy

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

## Other

- **Enumeration date:** 09/29/2022
- **Last updated:** 09/29/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1407835382 | — | IN |