Kevin D. Banner

NPI #1871763649 in Burley, Idaho

Provider Information

NPI Number: 1871763649
Entity Type: Organization
Organization Name: Kevin D. Banner
Primary Specialty: Dentist
Enumeration Date: Mar 7, 2008
Last Updated: Mar 7, 2008

Practice Location

Address: 1010 E MAIN ST
City: Burley
State: Idaho
ZIP Code: 83318-2045
Phone: (208) 678-5597

Authorized Official

Name: ECHO S ROBERTS
Title: OFFICE MANAGER
Phone: (208) 678-5597

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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