Organization
KEVIN D. BANNER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ECHO S ROBERTS (OFFICE MANAGER)
(208) 678-5597
Entity
Organization
Contact information
Practice address
1010 E MAIN ST, BURLEY, ID 83318-2045
(208) 678-5597
(208) 678-5663
Mailing address
1010 E MAIN ST, BURLEY, ID 83318-2045
(208) 678-5597
(208) 678-5663
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1892
ID
Other
Enumeration date
03/07/2008
Last updated
03/07/2008
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