Michael Dwaine Banks, D.D.S.
Individual provider Active NPI General Practice Dentistry · Jacksonville, TX
NPI 1497971097 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1497971097
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 10566 (TX)
- Practice address
- 606 Brookside Dr
Jacksonville, TX 75766-2519 - Phone
- (903) 586-1551
- Fax
- (903) 586-1552
- NPI assigned
- Apr 18, 2007
- 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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jacksonville Smiles | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10566 | TX | Yes |
Addresses
Primary practice location
606 Brookside Dr
Jacksonville, TX 75766-2519
Mailing address
606 Brookside Dr
Jacksonville, TX 75766-2519
Phone (903) 586-1551
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All providers in Jacksonville, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.