Banghart, Philip R
Banghart, Philip R is an sole proprietor health care provider with primary practice located at 102 Professional Plz , Mattoon IL 61938-9252. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Banghart, Philip R can be contacted via phone (217) 345-7070.Contact Information
Primary practice address
102 Professional Plz
Mattoon IL 61938-9252
Phone: (217) 345-7070
Fax: (217) 345-7077
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 019-021176 | Illinois |
Profile Details
| NPI number | 1982609087 |
|---|---|
| LBN Legal business name | Banghart, Philip R |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 15th, 2005 |
| Last updated | Nov 10th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1982609087 | NPPES |
| Illinois | MEDICAID | 019-021176 |
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