Charles Banister, DMD
Individual provider Active NPI Dentist · Derry, NH
NPI 1164848693 · NPPES record last updated Dec 22, 2021
Key facts
- NPI
- 1164848693
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- NH 2371 (NH)
- Practice address
- 30 Pinkerton St
Derry, NH 03038-1504 - Phone
- (603) 432-3335
- Fax
- (603) 434-8593
- NPI assigned
- Mar 7, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NH 2371 | NH | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charles C Banister DMD | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | NH 2371 | NH | Yes |
Addresses
Primary practice location
30 Pinkerton St
Derry, NH 03038-1504
Mailing address
30 Pinkerton St
Derry, NH 03038-1504
Phone (603) 432-3335
Other providers in Derry, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.