| Banstola | |
|
2315 Brockett Rd Tucker GA 30084-4412 | |
| (770) 934-1698 | |
| Not Available |
| Full Name | Banstola |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2315 Brockett Rd, Tucker, Georgia |
| Authorized Official Name and Position | Basu Banstola (OWNER DENTIST) |
| Authorized Official Contact | 7709341698 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Banstola Po Box 2635 Tucker GA 30085-2635 Ph: () - | Banstola 2315 Brockett Rd Tucker GA 30084-4412 Ph: (770) 934-1698 |
| NPI Number | 1114685740 |
|---|---|
| Provider Enumeration Date | 12/01/2021 |
| Last Update Date | 12/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114685740 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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