Provider Demographics
NPI:1538228341
Name:ROBERT BANG, D.D.S., INC.
Entity type:Organization
Organization Name:ROBERT BANG, D.D.S., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-446-8688
Mailing Address - Street 1:911 W. PERDEW AVE.
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3105
Mailing Address - Country:US
Mailing Address - Phone:760-446-8688
Mailing Address - Fax:760-446-8691
Practice Address - Street 1:911 W. PERDEW AVE.
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3105
Practice Address - Country:US
Practice Address - Phone:760-446-8688
Practice Address - Fax:760-446-8691
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT BANG, D.D.S., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-07
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB43114OtherHEALTHY FAMILIES
CAG92759OtherMEDI-CAL PROVIDER #
CA1524471OtherUNITED CONCORDIA