Provider Demographics
NPI:1174549430
Name:BANKER, LAWRENCE K (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:K
Last Name:BANKER
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 1:200 LITTLE FALLS ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4302
Mailing Address - Country:US
Mailing Address - Phone:703-237-7725
Mailing Address - Fax:703-237-7729
Practice Address - Street 1:200 LITTLE FALLS ST
Practice Address - Street 2:SUITE #101
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4302
Practice Address - Country:US
Practice Address - Phone:703-237-7725
Practice Address - Fax:703-237-7729
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010057731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00B180S83Medicare ID - Type Unspecified