Brent Dee Bankhead, DDS, MS Valid NPI

Individual provider · Orthodontics and Dentofacial Orthopedics Dentistry · O Fallon, MO

NPI

1609917905

Type

Individual (Type 1)

Primary specialty

Orthodontics and Dentofacial Orthopedics Dentistry (Dentist)

Specialty group

Dental Providers

Taxonomy code

1223X0400X

License number

015876 (MO)

Sex

Male

Sole proprietor

Yes

Enumerated

2007-02-09

Last updated

2007-07-08