Provider Demographics
NPI:1134383458
Name:BANKHEAD, DANIEL O (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:O
Last Name:BANKHEAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8519 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-6849
Mailing Address - Country:US
Mailing Address - Phone:225-766-1765
Mailing Address - Fax:225-766-6894
Practice Address - Street 1:8519 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-6849
Practice Address - Country:US
Practice Address - Phone:225-766-1765
Practice Address - Fax:225-766-6894
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist