Dr. Jackie L Banahan
Pediatric Dentist
3141 Beaumont Centre Cir Suite 100
Lexington
, Kentucky 40513-1934
Dr. Jackie L Banahan
Pediatric Dentist
3141 Beaumont Centre Cir Suite 100
Lexington
, Kentucky 40513-1934
(859) 296-4688
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About
Features
Specialties
- Pediatric Dentist
Languages spoken
- English
Location
First Address
- Dr. Jackie L Banahan
- 3141 Beaumont Centre Cir Suite 100
- Lexington, KY
- Zip : 40513-1934
- Fax : (859) 296-4688
- Phone : (859) 223-4888
Second Address
- Dr. Jackie L Banahan
- 3141 Beaumont Centre Cir Suite 100
- Lexington, KY
- Zip : 40513-1934
- Fax : (859) 296-4688
- Phone : (859) 223-4888
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0221X | Pediatric Dentist | 4977 | KY |
National Provider Identifier
| NPI | 1093866154 |
|---|---|
| Provider Name | Dr. Jackie L Banahan |
| First Address | Lexington, KY 40513-1934 |
| Second Address | Lexington, KY 40513-1934 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 16/01/2007 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 60049772 | (05) | KY |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.