Organization
AFFILIATES IN ORAL & MAXILLOFACIAL SURGERY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP R. BANGHART DDS (PRESIDENT/ORAL SURGEON)
(217) 351-7111
Entity
Organization
Contact information
Practice address
3112 VILLAGE OFFICE PL, CHAMPAIGN, IL 61822-7680
(217) 351-7111
(217) 351-7282
Mailing address
3112 VILLAGE OFFICE PL, CHAMPAIGN, IL 61822-7680
(217) 351-7111
(217) 351-7282
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019021176
IL
Other
Enumeration date
06/05/2008
Last updated
06/05/2008
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