Thomas M. Banta, D.D.S., PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

THOMAS M. BANTA, D.D.S., PC

Doing business as

Thomas M. Banta, D.D.S., PC

Practice address

1413 W Votaw St
Portland, IN 47371-9501

Phone

(260) 726-7822

NPI assigned

Sep 29, 2022

Organization subpart

No

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

Authorized official

Name

Thomas M. BantaNPI 1407835382

Title

Owner

Phone

(260) 726-7822

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Thomas M. Banta, D.D.S., PC Doing business as

Practitioners 1

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

• Thomas M. Banta, D.D.S.

  • General Practice Dentistry
  • Portland, IN
  • NPI 1407835382
  NPD Authorized official

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

{
    "created_epoch": "1664409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664409600000",
    "number": "1790409092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1413 W VOTAW ST",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473719501",
            "telephone_number": "260-726-7822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1413 W VOTAW ST",
            "city": "PORTLAND",
            "state": "IN",
            "postal_code": "473719501",
            "telephone_number": "260-726-7822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS M. BANTA, D.D.S., PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-29",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A",
        "authorized_official_last_name": "BANTA",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-726-7822"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407835382",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thomas M. Banta, D.D.S., PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark Weiler Tatman, DDS
• The Eye Center Group LLC (Portland Eye Center)
• The Jay School Corporation
• The Portland Dental Place
• Jamie Thobe
• Danielle Thompson
• Jonathon Treon
• Tricounty Surgical Assoc., PC
• Som Dutt Tyagi, MD
• Marianne Valentine, PT

• General Practice Dentistry in Portland, IN
• Providers in Portland, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; 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.