Dr. Philip R Banghart, D.D.S.
Dentist, Oral and Maxillofacial Surgery in Mattoon, IL. Individual provider (NPI-1).
NPI number1982609087
StatusActive
Last updated in NPPESNov 10, 2008
Details
- NPI
- 1982609087
- Entity type
- Individual (NPI-1)
- Name
- Dr. Philip R Banghart
- Credential
- D.D.S.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 15, 2005
- Last updated
- Nov 10, 2008
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223S0112X | Dentist, Oral and Maxillofacial Surgery | 019-021176 | IL | Yes |
Practice location
102 Professional PlzMattoon, IL 61938-9252
Phone 217-345-7070 · Fax 217-345-7077
Mailing address
102 Professional PlzMattoon, IL 61938-9252
Phone 217-345-7070 · Fax 217-345-7077
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