Provider Demographics
NPI:1568759843
Name:STEPHANIE BANGS, DDS, PC
Entity Type:Organization
Organization Name:STEPHANIE BANGS, DDS, PC
Other - Org Name:PECAN PARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-798-8912
Mailing Address - Street 1:912 N FIELDER RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3146
Mailing Address - Country:US
Mailing Address - Phone:817-275-4355
Mailing Address - Fax:817-275-1241
Practice Address - Street 1:912 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3146
Practice Address - Country:US
Practice Address - Phone:817-275-4355
Practice Address - Fax:817-275-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty