Provider Demographics
NPI:1134348626
Name:BANYAS AND MIRANDA, D.D.S.
Entity type:Organization
Organization Name:BANYAS AND MIRANDA, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-928-0265
Mailing Address - Street 1:216 W WATAUGA AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5624
Mailing Address - Country:US
Mailing Address - Phone:423-928-0265
Mailing Address - Fax:423-928-0265
Practice Address - Street 1:216 W WATAUGA AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5624
Practice Address - Country:US
Practice Address - Phone:423-928-0265
Practice Address - Fax:423-928-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty