Provider Demographics
NPI:1659583698
Name:BANG, ROBERT LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LOUIS
Last Name:BANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 NORTHWEST BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2134
Mailing Address - Country:US
Mailing Address - Phone:614-457-5173
Mailing Address - Fax:614-457-3535
Practice Address - Street 1:3230 NORTHWEST BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2134
Practice Address - Country:US
Practice Address - Phone:614-457-5173
Practice Address - Fax:614-457-3535
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH215571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice