| Dr. Brent S. Banner | |
|
1010 E Main St Burley ID 83318-2045 | |
| (208) 678-5597 | |
| Not Available |
| Full Name | Dr. Brent S. Banner |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1010 E Main St, Burley, Idaho |
| Authorized Official Name and Position | Brent Banner (OWNER) |
| Authorized Official Contact | 2086785597 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Brent S. Banner 1010 East Main Burley ID 83318-2045 Ph: () - | Dr. Brent S. Banner 1010 E Main St Burley ID 83318-2045 Ph: (208) 678-5597 |
| NPI Number | 1437329356 |
|---|---|
| Provider Enumeration Date | 03/06/2008 |
| Last Update Date | 03/06/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437329356 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D3028 (Idaho) | Primary |
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