Provider Demographics
NPI:1447143599
Name:BANIYA, SOICHCHHA (DDS)
Entity type:Individual
Prefix:DR
First Name:SOICHCHHA
Middle Name:
Last Name:BANIYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 N MERIDIAN AVE APT 412
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1216
Mailing Address - Country:US
Mailing Address - Phone:571-524-2727
Mailing Address - Fax:
Practice Address - Street 1:304 S AIR DEPOT BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4433
Practice Address - Country:US
Practice Address - Phone:405-689-5069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK80171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice