Healthcare Provider Details

I. General information

NPI: 1174500359
Provider Name (Legal Business Name): DAVID C. LANGLEY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST STREET & MINNESOTA HIGHWAY 60 LOWER LEVEL OF FIRST STATE BANK OF RED WING
MAZEPPA MN
55956
US

IV. Provider business mailing address

645 W 3RD ST
ZUMBROTA MN
55992-1037
US

V. Phone/Fax

Practice location:
  • Phone: 507-843-5734
  • Fax:
Mailing address:
  • Phone: 507-732-7682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9359
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: