Nathanael Bannon, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

00202572 Issued in CO

Practice address

3208 N Academy Blvd Ste 140
Colorado Springs, CO 80917-5111

Phone

(719) 301-5300

Fax

(719) 301-5303

NPI assigned

Aug 18, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1439856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439856000000",
    "number": "1750757423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3208 N ACADEMY BLVD STE 140",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175111",
            "telephone_number": "719-301-5300",
            "fax_number": "719-301-5303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3208 N ACADEMY BLVD STE 140",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175111",
            "telephone_number": "719-301-5300",
            "fax_number": "719-301-5303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANNON",
        "first_name": "NATHANAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-18",
        "last_updated": "2015-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "00202572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rakeyia Banks
• Stacy Catherine Banks, RMT
• Meagan Banning Barber, PT, DPT
• Margaret A Banning, MSN RN CNS
• Ashley Bannister
• Ariel Banos
• Stephen Banta
• Christina L Bantz
• Christina Marie Banuelos, DPT
• Maria Banuelos

• Dentist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Dentist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.