Healthcare Provider Details

I. General information

NPI: 1376693572
Provider Name (Legal Business Name): RON BANIK DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 NORTHPARK BLVD SUITE B
NORTH CHARLESTON SC
29406-9220
US

IV. Provider business mailing address

8720 NORTHPARK BLVD SUITE B
NORTH CHARLESTON SC
29406-9220
US

V. Phone/Fax

Practice location:
  • Phone: 843-553-0911
  • Fax: 843-553-0981
Mailing address:
  • Phone: 843-553-0911
  • Fax: 843-553-0981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MANENDU BANIK
Title or Position: OWNER/CEO
Credential: DMD
Phone: 843-553-0911