Philip R Banghart, D.D.S. Valid NPI

Individual provider · Oral and Maxillofacial Surgery (Dentist) · Mattoon, IL

NPI

1982609087

Type

Individual (Type 1)

Primary specialty

Oral and Maxillofacial Surgery (Dentist) (Dentist)

Specialty group

Dental Providers

Taxonomy code

1223S0112X

License number

019-021176 (IL)

Sex

Male

Sole proprietor

Yes

Enumerated

2005-06-15

Last updated

2008-11-10