Individual
DR. RANDY PAUL BANIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
910 I ST, LA PORTE, IN 46350-5533
(219) 325-0202
Mailing address
910 I ST, LA PORTE, IN 46350-5533
(219) 325-0202
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
IN9219
IN
Other
Enumeration date
04/03/2007
Last updated
07/08/2007
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