PHILIP R BANGHART DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****00

License Status

ACTIVE

Business

First Name

PHILIP R

Last Name

BANGHART

Suffix

DDS

Business Name

PHILIP R BANGHART DDS

Original Issue Date

05/02/1995

Effective Date

05/02/2024

Expiration Date

09/30/2027

City

MATTOON

State

Zip

61938

County

COLES

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

05/02/2024