Wade M Banner, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

63601 Issued in CA

Practice address

2060 E Route 66 Ste 105
Glendora, CA 91740-4691

Phone

(626) 594-0374

Fax

(626) 594-0813

NPI assigned

Jul 14, 2014

Sex

Male

Sole proprietor

Yes

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 CA

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dental Corporation of Wade Melvin Banner DMD Inc

  • Dental Clinic/Center
  • La Verne, CA
  • NPI 1669182333
  NPD Authorized official
• Wade Melvin Banner D.M.D., Inc

  • Dentist
  • Glendora, CA
  • NPI 1417357518
  NPD Authorized official

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

{
    "created_epoch": "1405296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1952718702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 W. FOOTHILL BLVD.",
            "address_2": "SUITE A",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917503223",
            "telephone_number": "626-594-0374",
            "fax_number": "626-594-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 E ROUTE 66 STE 105",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917404691",
            "telephone_number": "626-594-0374",
            "fax_number": "626-594-0813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANNER",
        "first_name": "WADE",
        "middle_name": "M",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-07-14",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "63601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bailey Care Homes, Inc.
• Odessie Jane Ciceron Balagtas
• Balance Care Wellness Group
• Katherene Balangauan, APRN
• Ilissa Banhazl, MFT
• Alejandro Barcelo
• Dalia Barcenas
• Chelsie Barcinas
• Jean William Bardenheier, M.D.
• Guadalupe E Barillas, P.T.

• General Practice Dentistry in Glendora, CA
• Providers in Glendora, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; 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.