Provider Demographics
NPI:1154876043
Name:BANICH & BANICH PLLC
Entity type:Organization
Organization Name:BANICH & BANICH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BANICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-684-4586
Mailing Address - Street 1:775 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2514
Mailing Address - Country:US
Mailing Address - Phone:509-684-4586
Mailing Address - Fax:509-685-1043
Practice Address - Street 1:775 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2514
Practice Address - Country:US
Practice Address - Phone:509-684-4586
Practice Address - Fax:506-685-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE600971611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty