Organization
SUSAN KAY BANTA DDS MS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN KAY BANTA DDS MS (PRESIDENT)
(910) 772-9770
Entity
Organization
Contact information
Practice address
1611 DOCTORS CIRCLE, WILMINGTON, NC 28401
(910) 772-9770
(910) 772-1553
Mailing address
1611 DOCTORS CIRCLE, WILMINGTON, NC 28401
(910) 772-9770
(910) 772-1553
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
—
Other
Enumeration date
12/19/2006
Last updated
12/17/2007
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