Healthcare Provider Details

I. General information

NPI: 1003089608
Provider Name (Legal Business Name): BRAVMAN LANGSTON AND ASSOCIATES ORAL & MAXILLOFACIAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WATERHOUSE RD
BOURNE MA
02532-8340
US

IV. Provider business mailing address

114 WATERHOUSE RD
BOURNE MA
02532-8340
US

V. Phone/Fax

Practice location:
  • Phone: 508-759-4495
  • Fax: 508-759-0840
Mailing address:
  • Phone: 508-759-4495
  • Fax: 508-759-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JOHN R. LANGSTON
Title or Position: OWNER
Credential: DDS, MS
Phone: 508-759-4495