Individual provider Active NPI

Neidre Janell Banakus, DDS

  • Pediatric Dentistry
  • Wendell, NC
National Provider Identifier
1205028396
Registry record updated May 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
11291 Issued in NC
Practice address
2255 Treelight Way
Wendell, NC 27591
Phone
(919) 200-0463
Fax
(919) 800-3692
NPI assigned
Aug 14, 2007
Last updated
May 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 11291 NC Primary

Addresses

Primary practice location

2255 Treelight Way
Wendell, NC 27591

Mailing address

2255 Treelight Way
Wendell, NC 27591
Phone (919) 200-0463

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11291NCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Neidre Janell Banakus DDS PC Pediatric Dentistry Current Accepting new patients
Neidre J Banakus DDS PC Wendell Pediatric Dentistry CurrentSince May 11, 2025 Accepting new patients
Neidre Banakus DDS PLLC Pediatric Dentistry CurrentSince May 11, 2025 Accepting new patients

Locations

224 Village Walk Dr
Holly Springs, NC 27540
Phone (919) 200-0463

2255 Treelight Way
Wendell, NC 27591
Phone (919) 200-0463

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1205028396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 TREELIGHT WAY",
            "city": "WENDELL",
            "state": "NC",
            "postal_code": "27591",
            "telephone_number": "919-200-0463",
            "fax_number": "919-800-3692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 TREELIGHT WAY",
            "city": "WENDELL",
            "state": "NC",
            "postal_code": "27591",
            "telephone_number": "919-200-0463",
            "fax_number": "919-800-3692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANAKUS",
        "first_name": "NEIDRE",
        "middle_name": "JANELL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-14",
        "last_updated": "2025-05-08",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "11291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wendell, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.