Provider Demographics
NPI:1043309479
Name:BANCHIK, OLYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:OLYA
Middle Name:
Last Name:BANCHIK
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 1:9935D REA RD STE 282
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6710
Mailing Address - Country:US
Mailing Address - Phone:704-654-6976
Mailing Address - Fax:702-360-3178
Practice Address - Street 1:9925 REA RD.
Practice Address - Street 2:STE 104
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173
Practice Address - Country:US
Practice Address - Phone:704-654-6976
Practice Address - Fax:704-288-4391
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC108871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6483960001Medicare NSC