Provider Demographics
NPI:1316122344
Name:ATASSI, BANA (DDS)
Entity type:Individual
Prefix:DR
First Name:BANA
Middle Name:
Last Name:ATASSI
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 1:801 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4286
Mailing Address - Country:US
Mailing Address - Phone:630-769-9940
Mailing Address - Fax:630-323-4909
Practice Address - Street 1:801 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-4286
Practice Address - Country:US
Practice Address - Phone:630-769-9940
Practice Address - Fax:630-323-4909
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL091023267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist