MEDICARE: DR. KRISTINA LYNNE LANGWORTHY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	58104	CA

General Provider Information

NPI Number	:	1104081512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINA LYNNE LANGWORTHY D.D.S.

Provider Business Mailing Address
First Line	:	2050 JUDAH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1531
Country	:	US
Telephone Number	:	415-652-1450
Fax Number	:	415-753-5437

Provider Business Practice Location Address
First Line	:	2050 JUDAH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-1531
Country	:	US
Telephone Number	:	415-681-5437
Fax Number	:	415-753-5437

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	11/24/2021

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