Charlotte E. Banker, DDS

Individual provider Active NPI General Practice Dentistry · Bossier City, LA

NPI 1962670075 · NPPES record last updated Feb 12, 2008

Key facts

NPI
1962670075
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
5859 (LA)
Practice address
2281 Benton Rd
Bossier City, LA 71111-3403
Phone
(318) 742-9852
NPI assigned
Feb 12, 2008
Sex
Female
Sole proprietor
No

Organizations & group practices 2

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
5859LAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Brigham and Brigham Professional Past Accepting new patients
Brigham and Brigham Sleep Care General Practice Past
since Sep 15, 2019
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5859 LA Yes

Addresses

Primary practice location

2281 Benton Rd
Bossier City, LA 71111-3403

Mailing address

2281 Benton Rd
Bossier City, LA 71111-3403
Phone (318) 742-9852

Other providers in Bossier City, LA

All providers in Bossier City, LA · General Practice Dentistry in Louisiana

Sources for this page

Verify at the official NPI Registry.