Provider Demographics
NPI:1548375116
Name:PHILLIP L. BANGLE, D.D.S. S.C.
Entity type:Organization
Organization Name:PHILLIP L. BANGLE, D.D.S. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:BANGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-542-1662
Mailing Address - Street 1:1425 SUMMIT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3200
Mailing Address - Country:US
Mailing Address - Phone:262-542-1662
Mailing Address - Fax:
Practice Address - Street 1:1425 SUMMIT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3200
Practice Address - Country:US
Practice Address - Phone:262-542-1662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty