Provider Demographics
NPI:1538296264
Name:BANICH, STEVEN GENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GENE
Last Name:BANICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2514
Mailing Address - Country:US
Mailing Address - Phone:509-684-4586
Mailing Address - Fax:509-685-1043
Practice Address - Street 1:775 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2514
Practice Address - Country:US
Practice Address - Phone:509-684-4586
Practice Address - Fax:509-685-1043
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000048981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice