| Jerome A Bannister Dds Inc | |
|
4370 Palm Ave Ste C San Diego CA 92154-1760 | |
| (619) 428-8682 | |
| (619) 428-1043 |
| Full Name | Jerome A Bannister Dds Inc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4370 Palm Ave, San Diego, California |
| Authorized Official Name and Position | Lizbeth Chavez (OFFICE MANAGER) |
| Authorized Official Contact | 6194288682 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jerome A Bannister Dds Inc 4370 Palm Ave Ste C San Diego CA 92154-1760 Ph: (619) 428-8682 | Jerome A Bannister Dds Inc 4370 Palm Ave Ste C San Diego CA 92154-1760 Ph: (619) 428-8682 |
| NPI Number | 1154310472 |
|---|---|
| Provider Enumeration Date | 10/19/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154310472 | NPI | - | NPPES |
| B38253 01 | Other | CA | MEDI CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 38253 (California) | Primary |
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