Michael Babon Banawis, D.D.S.
Individual provider Active NPI Dentist · Duarte, CA
NPI 1689785271 · NPPES record last updated Aug 31, 2012
Key facts
- NPI
- 1689785271
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 49278 (CA)
- Practice address
- 1745 Huntington Dr.
Duarte, CA 91010 - Phone
- (626) 357-9801
- Fax
- (626) 358-1706
- NPI assigned
- Aug 31, 2006
- 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 |
|---|---|---|---|
| 49278 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michael Banawis DDS Professional Corporation | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 49278 | CA | Yes |
Addresses
Primary practice location
1745 Huntington Dr.
Duarte, CA 91010
Mailing address
1745 Huntington Dr.
Duarte, CA 91010
Phone (626) 357-9801
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 523009 | Other | CA | DENTICAL |
Other providers in Duarte, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2012. 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.