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General NPI Number Information
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NPI Number | 1104032275
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Entity Type | Organization
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Legal Business Name | TIMOTHY C. LANG, DDS, MD, PA
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 04/13/2016
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Provider Practice Location Address
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Address Line | 2030 S PATRICK DR SUITE 1
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4400
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Country | US
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Telephone | 321-777-2166
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Fax | 321-777-2191
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Provider Business Mailing Address
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Address Line | 2030 S PATRICK DR SUITE 1
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-4400
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Country | US
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Telephone | 321-777-2166
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Fax | 321-777-2191
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Authorized Official
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Title or Position | CEO
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Name | DR. TIMOTHY CORRIGAN LANG
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Credential | DDS, MD
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Telephone | 321-777-2166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | ME0068501
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License Number State | FL
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