=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952505802
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RINGO V BANGALAN DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2007
-----------------------------------------------------
Last Update Date | 03/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15618 GALE AVE
-----------------------------------------------------
City | HACIENDA HEIGHTS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91745-1514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-961-8878
-----------------------------------------------------
Fax | 626-961-8836
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18621 DEVLIN AVE
-----------------------------------------------------
City | ARTESIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90701-5818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-379-8192
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 55678
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------