Individual
DR. PHILIP R BANGHART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
102 PROFESSIONAL PLZ, MATTOON, IL 61938-9252
(217) 345-7070
(217) 345-7077
Mailing address
102 PROFESSIONAL PLZ, MATTOON, IL 61938-9252
(217) 345-7070
(217) 345-7077
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019-021176
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019-021176
—
IL
Enumeration date
06/15/2005
Last updated
11/10/2008
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