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General NPI Number Information
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NPI Number | 1154876043
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Entity Type | Organization
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Legal Business Name | BANICH & BANICH PLLC
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Dates
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Enumeration Date | 08/20/2016
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Last Update Date | 08/20/2016
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Provider Practice Location Address
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Address Line | 775 S MAIN ST SUITE C
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City | COLVILLE
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State | WA
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Zip | 99114-2514
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Country | US
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Telephone | 509-684-4586
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Fax | 506-685-1043
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Provider Business Mailing Address
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Address Line | 775 S MAIN ST SUITE C
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City | COLVILLE
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State | WA
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Zip | 99114-2514
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Country | US
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Telephone | 509-684-4586
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Fax | 509-685-1043
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JEFFREY BANICH
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Credential | DMD
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Telephone | 509-684-4586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DE60097161
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License Number State | WA
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