Provider Demographics
NPI:1821125659
Name:ERIN BANG DDS PC
Entity Type:Organization
Organization Name:ERIN BANG DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANG-CROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-455-0466
Mailing Address - Street 1:PO BOX 80097
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30366-0097
Mailing Address - Country:US
Mailing Address - Phone:770-455-0466
Mailing Address - Fax:770-458-0356
Practice Address - Street 1:5718 BUFORD HWY NE
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1207
Practice Address - Country:US
Practice Address - Phone:770-455-0466
Practice Address - Fax:770-458-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty