Provider Demographics
NPI:1376693572
Name:RON BANIK DMD PC
Entity Type:Organization
Organization Name:RON BANIK DMD PC
Other - Org Name:CAROLINA FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MANENDU
Authorized Official - Middle Name:
Authorized Official - Last Name:BANIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-553-0911
Mailing Address - Street 1:8720 NORTHPARK BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH 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:SUITE B
Practice Address - City:NORTH 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9768Medicaid