Provider Demographics
NPI:1093928046
Name:BANCUK, JANE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:E
Last Name:BANCUK
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 1:7184 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3552
Mailing Address - Country:US
Mailing Address - Phone:734-844-8438
Mailing Address - Fax:
Practice Address - Street 1:7184 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3552
Practice Address - Country:US
Practice Address - Phone:734-844-8438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010132451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
264873OtherUNITED CONCORDIA INS
MID132450OtherBLUE CROSS BLUE SHIELD MI