Healthcare Provider Details

I. General information

NPI: 1841379542
Provider Name (Legal Business Name): RAYMOND LANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 BERING ST
NOME AK
99762-0812
US

IV. Provider business mailing address

PO BOX 1730
NOME AK
99762-0812
US

V. Phone/Fax

Practice location:
  • Phone: 907-443-2055
  • Fax: 907-443-3696
Mailing address:
  • Phone: 907-443-2055
  • Fax: 907-443-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number323
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: