Healthcare Provider Details

I. General information

NPI: 1285916312
Provider Name (Legal Business Name): LANGENBACH-THOMAS DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E 3RD AVE
ESCONDIDO CA
92025-4254
US

IV. Provider business mailing address

127 E 3RD AVE
ESCONDIDO CA
92025-4254
US

V. Phone/Fax

Practice location:
  • Phone: 760-741-1231
  • Fax: 760-741-8961
Mailing address:
  • Phone: 760-741-1231
  • Fax: 760-741-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50872
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. LYNNE D THOMAS
Title or Position: OWNER
Credential: DDS
Phone: 760-741-1231