Individual
ALEXANDER BANNOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
130 CANAL ST, SUITE 204, POOLER, GA 31322-4085
(912) 748-5868
(912) 748-6778
Mailing address
130 CANAL ST, SUITE 204, POOLER, GA 31322-4085
(912) 748-5868
(912) 748-6778
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2901019341
MI
1223G0001X
General Practice Dentistry
Primary
DN013382
GA
Other
Enumeration date
11/02/2006
Last updated
09/24/2010
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