Organization
DENTAL CORPORATION OF WADE MELVIN BANNER DMD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WADE BANNER DMD (OWNER)
(909) 973-0099
Entity
Organization
Contact information
Practice address
929 FOOTHILL BLVD STE B, LA VERNE, CA 91750-3223
(909) 973-0099
Mailing address
929 FOOTHILL BLVD STE B, LA VERNE, CA 91750-3223
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/02/2022
Last updated
12/02/2022
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