Organization
THOMAS M. BANTA, D.D.S., PC
Active
Other names
Thomas M. Banta, D.D.S., PC
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS M. BANTA (OWNER)
(260) 726-7822
Entity
Organization
Contact information
Practice address
1413 W VOTAW ST, PORTLAND, IN 47371-9501
(260) 726-7822
Mailing address
1413 W VOTAW ST, PORTLAND, IN 47371-9501
(260) 726-7822
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407835382
—
IN
Enumeration date
09/29/2022
Last updated
09/29/2022
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