Provider Demographics
NPI:1245192277
Name:BANKE DENTAL HEALTH ORGANIZATION
Entity type:Organization
Organization Name:BANKE DENTAL HEALTH ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:GIOVANNI
Authorized Official - Last Name:BANKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-801-8060
Mailing Address - Street 1:3587 BIRCH STREET
Mailing Address - Street 2:SUITE 327
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:714-801-8060
Mailing Address - Fax:
Practice Address - Street 1:13420 NEWPORT AVE STE A
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3745
Practice Address - Country:US
Practice Address - Phone:714-801-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-28
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty