Individual
DR. EDWARD M BANCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3504 EAST MARIA DRIVE, STEVENS POINT, WI 54481
(715) 342-8060
Mailing address
3504 EAST MARIA DRIVE, STEVENS POINT, WI 54481
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
33787500
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38392500
—
WI
Enumeration date
05/25/2007
Last updated
07/09/2007
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