# BANICH & BANICH PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154876043
- **Authorized official:** DR. JEFFREY BANICH DMD (OWNER/DENTIST)
- **Authorized official phone:** (509) 684-4586

## Contact information

- **Practice address:** 775 S MAIN ST, SUITE C, COLVILLE, WA 99114-2514
- **Practice address phone:** (509) 684-4586
- **Practice address fax:** (506) 685-1043
- **Mailing address:** 775 S MAIN ST, SUITE C, COLVILLE, WA 99114-2514
- **Mailing address phone:** (509) 684-4586
- **Mailing address fax:** (509) 685-1043

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE60097161 | WA | Yes |

## Other

- **Enumeration date:** 08/20/2016
- **Last updated:** 08/20/2016