Provider Demographics
NPI:1154747293
Name:CHARLES C BANISTER DMD
Entity type:Organization
Organization Name:CHARLES C BANISTER DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BANISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:603-432-3335
Mailing Address - Street 1:1 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2101
Mailing Address - Country:US
Mailing Address - Phone:603-432-3335
Mailing Address - Fax:603-434-8593
Practice Address - Street 1:1 BIRCH ST
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2101
Practice Address - Country:US
Practice Address - Phone:603-432-3335
Practice Address - Fax:603-434-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH23711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty