Provider Demographics
NPI:1215345152
Name:BANH, JEAN-PAUL (DDS)
Entity type:Individual
Prefix:
First Name:JEAN-PAUL
Middle Name:
Last Name:BANH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 D ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5528
Mailing Address - Country:US
Mailing Address - Phone:253-397-4030
Mailing Address - Fax:
Practice Address - Street 1:110 D ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5528
Practice Address - Country:US
Practice Address - Phone:253-397-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE604758031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice