Provider Demographics
NPI:1285828228
Name:BANGA, POOJA (DMD)
Entity Type:Individual
Prefix:DR
First Name:POOJA
Middle Name:
Last Name:BANGA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:POOJA
Other - Middle Name:
Other - Last Name:TRIPATHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231
Mailing Address - Country:US
Mailing Address - Phone:716-204-4999
Mailing Address - Fax:716-632-2963
Practice Address - Street 1:1581 WEST RIVER RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-324-2167
Practice Address - Fax:440-324-2160
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist