Provider Demographics
NPI:1558450965
Name:BANCHIK, LEONID (DMD)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:BANCHIK
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 1:9400 S EASTERN AVE
Mailing Address - Street 2:101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-7936
Mailing Address - Country:US
Mailing Address - Phone:702-456-0009
Mailing Address - Fax:702-458-0009
Practice Address - Street 1:6708 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-3856
Practice Address - Country:US
Practice Address - Phone:704-537-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist