Individual
LAEL B BANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6340 LITTLEROCK RD SW, TUMWATER, WA 98512-7332
(360) 786-1313
(360) 786-1603
Mailing address
2216 9TH AVE SW, OLYMPIA, WA 98502-5138
(360) 786-1313
(360) 786-1603
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
00009682
WA
Other
Enumeration date
07/27/2006
Last updated
07/08/2007
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