Organization
DALLAS ORAL AND MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID M BANTA (OWNER/DR)
(214) 363-6415
Entity
Organization
Contact information
Practice address
6140 SHERRY LANE, DALLAS, TX 75225
(214) 363-6415
Mailing address
6140 SHERRY LN, DALLAS, TX 75225-6301
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
13059
TX
Other
Enumeration date
10/08/2010
Last updated
10/08/2010
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