Healthcare Provider Details

I. General information

NPI: 1558451997
Provider Name (Legal Business Name): ROBERT A LANG JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1859 LAKE ROAD
HAMLIN NY
14464
US

IV. Provider business mailing address

1859 LAKE ROAD
HAMLIN NY
14464
US

V. Phone/Fax

Practice location:
  • Phone: 585-964-2000
  • Fax: 585-964-5735
Mailing address:
  • Phone: 585-964-2000
  • Fax: 585-964-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number037734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: