Individual provider · Type 1 NPI
Philip R. Banghart, DDS
Oral and Maxillofacial Surgery (Dentist) · Mattoon, IL
NPI number
1982609087
Active
Practice location
102 Professional Plz
Mattoon, IL 61938-9252
Fax (217) 345-7077
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) Primary | 1223S0112X | 019-021176 (IL) |
Oral and Maxillofacial Surgery (Dentist): The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
About NPI 1982609087
Philip R. Banghart, DDS's National Provider Identifier is 1982609087, issued on Jun 15, 2005. The primary taxonomy on file is Oral and Maxillofacial Surgery (Dentist) (1223S0112X), and the practice location is in Mattoon, IL. The record was last updated on Nov 10, 2008.