Healthcare Provider Details

I. General information

NPI: 1265744494
Provider Name (Legal Business Name): MARC O'SHEA LANGLAND D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17425 VASHON HWY SW
VASHON WA
98070-4653
US

IV. Provider business mailing address

PO BOX 673
VASHON WA
98070-0673
US

V. Phone/Fax

Practice location:
  • Phone: 206-463-9282
  • Fax: 206-463-6343
Mailing address:
  • Phone: 206-463-9282
  • Fax: 206-463-6343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60167286
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: