Provider Demographics
NPI:1124853072
Name:MAVERICK BANI, D.D.S., INC.
Entity type:Organization
Organization Name:MAVERICK BANI, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAVERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-993-0417
Mailing Address - Street 1:620 N ARDEN DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3510
Mailing Address - Country:US
Mailing Address - Phone:310-993-0417
Mailing Address - Fax:
Practice Address - Street 1:709 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4558
Practice Address - Country:US
Practice Address - Phone:626-797-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental