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Individual

DR. JEFFREY S BANICH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
775 S MAIN ST STE C, COLVILLE, WA 99114-2514
(509) 684-4586
Mailing address
341 ROCKY LAKE RD, COLVILLE, WA 99114-9755
(509) 684-3195

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE60097161
WA

Other

Enumeration date
07/23/2009
Last updated
07/23/2009
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