Provider Demographics
NPI:1447875927
Name:BANG, JOHN M (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:BANG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 W DESERT INN RD APT 2054
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9122
Mailing Address - Country:US
Mailing Address - Phone:213-407-9097
Mailing Address - Fax:
Practice Address - Street 1:250 E HANFORD ARMONA RD
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2132
Practice Address - Country:US
Practice Address - Phone:559-997-6140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty