| NPI | 1215196290 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP R. BANGHART President/Oral Surgeon 217-351-7111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019021176) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-06-05 |