Healthcare Provider Details

I. General information

NPI: 1801464672
Provider Name (Legal Business Name): IRENE LANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1372 HANCOCK ST STE 101
QUINCY MA
02169-5107
US

IV. Provider business mailing address

2181 WASHINGTON ST
ROXBURY MA
02119-2082
US

V. Phone/Fax

Practice location:
  • Phone: 617-472-3919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1859135
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: