Kevin D. Banner

Primary specialty

DentistTaxonomy code 122300000X

License

D1892 Issued in ID

Legal business name

KEVIN D. BANNER

Practice address

1010 E Main St
Burley, ID 83318-2045

Phone

(208) 678-5597

Fax

(208) 678-5663

NPI assigned

Mar 7, 2008

Organization subpart

No

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

Authorized official

Name

Echo S Roberts

Title

Office Manager

Phone

(208) 678-5597

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1204848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204848000000",
    "number": "1871763649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 E MAIN ST",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182045",
            "telephone_number": "208-678-5597",
            "fax_number": "208-678-5663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 E MAIN ST",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182045",
            "telephone_number": "208-678-5597",
            "fax_number": "208-678-5663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN D. BANNER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-07",
        "last_updated": "2008-03-07",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "ECHO",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-678-5597"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "ID",
            "license": "D1892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ellen K Judd, P.A.
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• Logan Kay, DMD
• Shane Ryan Kelsey, MS, LPC
• Michael P Klett, D.O.
• Kaity Kobayashi, PT, DPT, PCS
• Heidi Lee Koepnick, LPC
• Susan L Koepnick, LPC
• Karrie Rae Kondel, ARNP

• Dentist in Burley, ID
• Providers in Burley, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2008; 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.