Individual
DR. JACKIE L BANAHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
3141 BEAUMONT CENTRE CIR, SUITE 100, LEXINGTON, KY 40513-1934
(859) 223-4888
(859) 296-4688
Mailing address
3141 BEAUMONT CENTRE CIR, SUITE 100, LEXINGTON, KY 40513-1934
(859) 223-4888
(859) 296-4688
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
4977
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60049772
—
KY
Enumeration date
01/16/2007
Last updated
07/08/2007
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