Provider Demographics
NPI:1093870032
Name:BANIK, MANENDU (DMD)
Entity Type:Individual
Prefix:DR
First Name:MANENDU
Middle Name:
Last Name:BANIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 NORTHPARK BLVD
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9220
Mailing Address - Country:US
Mailing Address - Phone:843-553-0911
Mailing Address - Fax:843-553-0981
Practice Address - Street 1:8720 NORTHPARK BLVD
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9220
Practice Address - Country:US
Practice Address - Phone:843-553-0911
Practice Address - Fax:843-553-0981
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9768Medicaid