Individual
DR. SUSAN KAY BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
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
5375
NC
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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