Provider Demographics
NPI:1184033284
Name:BIANCHI, ERIK
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:BIANCHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PENDLETON RD
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2262
Mailing Address - Country:US
Mailing Address - Phone:864-654-0230
Mailing Address - Fax:
Practice Address - Street 1:211 PENDLETON RD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2262
Practice Address - Country:US
Practice Address - Phone:864-654-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice