PHILIP R BANGHART DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****01

License Status

NOT RENEWED

Business

First Name

PHILIP R

Last Name

BANGHART

Suffix

DDS

Business Name

PHILIP R BANGHART DDS

Original Issue Date

05/02/1995

Effective Date

05/02/1995

Expiration Date

09/30/1998

City

CHAMPAIGN

State

Zip

61820

County

CHAMPAIGN

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

10/13/2005