Provider Demographics
NPI:1699308031
Name:S. T. BANATAO DDS INC.
Entity type:Organization
Organization Name:S. T. BANATAO DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOFRONIO
Authorized Official - Middle Name:TOLENTINO
Authorized Official - Last Name:BANATAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-796-3441
Mailing Address - Street 1:35124 NEWARK BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1220
Mailing Address - Country:US
Mailing Address - Phone:510-796-3441
Mailing Address - Fax:510-796-3475
Practice Address - Street 1:35124 NEWARK BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-1220
Practice Address - Country:US
Practice Address - Phone:510-796-3441
Practice Address - Fax:510-796-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty