Provider Demographics
NPI:1811467301
Name:OLYA BANCHIK DDS PLLC
Entity type:Organization
Organization Name:OLYA BANCHIK DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-654-6976
Mailing Address - Street 1:9935D REA RD STE 282
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6710
Mailing Address - Country:US
Mailing Address - Phone:704-654-6976
Mailing Address - Fax:
Practice Address - Street 1:9925 REA RD.
Practice Address - Street 2:STE 104
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173
Practice Address - Country:US
Practice Address - Phone:704-654-6976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental