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General NPI Number Information
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NPI Number | 1821125659
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Entity Type | Organization
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Legal Business Name | ERIN BANG DDS PC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 5718 BUFORD HWY NE
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City | DORAVILLE
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State | GA
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Zip | 30340-1207
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Country | US
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Telephone | 770-455-0466
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Fax | 770-458-0356
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Provider Business Mailing Address
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Address Line | PO BOX 80097
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City | CHAMBLEE
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State | GA
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Zip | 30366-0097
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Country | US
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Telephone | 770-455-0466
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Fax | 770-458-0356
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ERIN BANG-CROOKS
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Credential |
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Telephone | 770-455-0466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN011829
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License Number State | GA
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