Provider Demographics
NPI:1477596625
Name:BANGERTER, CHAD CORY (DDS)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:CORY
Last Name:BANGERTER
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:CMR 411 BOX 4542
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112-0046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DENTAC BAVARIA CMR 411
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:NY
Practice Address - Zip Code:09112-8053
Practice Address - Country:US
Practice Address - Phone:910-723-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5368603-9921122300000X
UT5368303-99211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist