Provider Demographics
NPI:1881801603
Name:BANGLOY, ELMER ESPANOLA (DDS)
Entity type:Individual
Prefix:DR
First Name:ELMER
Middle Name:ESPANOLA
Last Name:BANGLOY
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 1:4128 VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3821
Mailing Address - Country:US
Mailing Address - Phone:323-256-1225
Mailing Address - Fax:323-230-6148
Practice Address - Street 1:4128 VERDUGO RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3821
Practice Address - Country:US
Practice Address - Phone:323-256-1225
Practice Address - Fax:323-230-6148
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADG-0320201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice