Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 319.015031 | IL |
NPI | 1003056342 |
---|---|
Provider Name | Christopher Paul Banks |
First Address | Bolingbrook, IL 60440-2281 |
Second Address | Bolingbrook, IL 60440-2281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2009 |
Last Update Date | 26/02/2009 |