Provider Demographics
NPI:1336359744
Name:BANKER, ANDREW R (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:BANKER
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 HOSPITAL DR
Mailing Address - Street 2:SUITE 132
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2167
Mailing Address - Country:US
Mailing Address - Phone:318-747-5812
Mailing Address - Fax:318-747-5841
Practice Address - Street 1:2250 HOSPITAL DR
Practice Address - Street 2:SUITE 132
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2167
Practice Address - Country:US
Practice Address - Phone:318-747-5812
Practice Address - Fax:318-747-5841
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6203204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1093360Medicaid
LA09336Medicaid