Individual
DR. KEVIN D. BANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1010 E MAIN ST, BURLEY, ID 83318-2045
(208) 678-5597
(208) 678-5663
Mailing address
1010 E MAIN ST, BURLEY, ID 83318-2045
(208) 678-5597
(208) 678-5663
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1892
ID
Other
Enumeration date
06/19/2006
Last updated
07/08/2007
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