NPIMap

Organization Active NPI

Wade Melvin Banner D.M.D., Inc

Doing business as In Motion Dentists

  • Dentist
  • Glendora, CA
National Provider Identifier
1417357518
Registry record updated May 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
63601 Issued in CA
Legal business name
WADE MELVIN BANNER D.M.D., INC
Doing business as
In Motion Dentists
Practice address
2060 E Route 66 Ste 105
Glendora, CA 91740-4691
Phone
(626) 594-0374
Fax
(626) 594-0813
NPI assigned
Aug 26, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2024

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

Authorized official

Name
Dr. Wade Melvin Banner, D.M.D.NPI 1952718702
Title
Owner
Phone
(626) 594-0374

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 63601 CA Primary
Dental Clinic/Center 261QD0000X

Addresses

Primary practice location

2060 E Route 66 Ste 105
Glendora, CA 91740-4691

Mailing address

929 W. Foothill Blvd.
Suite a
La Verne, CA 91750-3223
Phone (626) 594-0374

Other names 1

  • In Motion Dentists Doing business as

National Provider Directory

National Provider Directory

Locations

2060 E Route 66
Ste 105
Glendora, CA 91740
Phone (626) 594-0374

929 Foothill Blvd
Ste A
La Verne, CA 91750
Phone (626) 428-3920

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1417357518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 W. FOOTHILL BLVD.",
            "address_2": "SUITE A",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917503223",
            "telephone_number": "626-594-0374",
            "fax_number": "626-594-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 E ROUTE 66 STE 105",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404691",
            "telephone_number": "626-594-0374",
            "fax_number": "626-594-0813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WADE MELVIN BANNER D.M.D., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-26",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "BANNER",
        "authorized_official_first_name": "WADE",
        "authorized_official_middle_name": "MELVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-594-0374",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "63601",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "In Motion Dentists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendora, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; 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.