Provider Demographics
NPI:1538898291
Name:BANWO, BABATUNDE MICHAEL (DMD)
Entity type:Individual
Prefix:
First Name:BABATUNDE
Middle Name:MICHAEL
Last Name:BANWO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14907 BREEZY FOREST LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-4722
Mailing Address - Country:US
Mailing Address - Phone:832-287-7038
Mailing Address - Fax:
Practice Address - Street 1:24020 CLAY RD STE 106
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-8137
Practice Address - Country:US
Practice Address - Phone:832-400-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX386211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice