Provider Demographics
NPI:1215945712
Name:BAN, KATHLEEN (DDS)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12132 SARATOGA SUNNYVALE RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-3046
Mailing Address - Country:US
Mailing Address - Phone:408-252-5678
Mailing Address - Fax:408-252-9028
Practice Address - Street 1:12132 SARATOGA SUNNYVALE RD
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-3046
Practice Address - Country:US
Practice Address - Phone:408-252-5678
Practice Address - Fax:408-252-9028
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice