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General NPI Number Information
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NPI Number | 1811467301
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Entity Type | Organization
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Legal Business Name | OLYA BANCHIK DDS PLLC
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 9925 REA RD. STE 104
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City | WAXHAW
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State | NC
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Zip | 28173
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Country | US
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Telephone | 704-654-6976
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Fax |
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Provider Business Mailing Address
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Address Line | 9935D REA RD STE 282
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City | CHARLOTTE
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State | NC
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Zip | 28277-6710
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Country | US
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Telephone | 704-654-6976
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. OLYA BANCHIK
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Credential | DDS
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Telephone | 704-654-6976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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