Organization
DR. BRENT S. BANNER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENT BANNER (OWNER)
(208) 678-5597
Entity
Organization
Contact information
Practice address
1010 E MAIN ST, BURLEY, ID 83318-2045
(208) 678-5597
Mailing address
1010 EAST MAIN, BURLEY, ID 83318-2045
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3028
ID
Other
Enumeration date
03/06/2008
Last updated
03/06/2008
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