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General NPI Number Information
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NPI Number | 1255744736
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Entity Type | Organization
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Legal Business Name | LESIA LANGSTON-MCKENNA, DMD, INC.
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 321 CHILLICOTHE AVE
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City | HILLSBORO
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State | OH
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Zip | 45133-7378
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Country | US
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Telephone | 937-393-1472
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Fax | 937-393-4824
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Provider Business Mailing Address
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Address Line | 321 CHILLICOTHE AVE
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City | HILLSBORO
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State | OH
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Zip | 45133-7378
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Country | US
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Telephone | 937-393-1472
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Fax | 937-393-4824
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Authorized Official
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Title or Position | PRESIDENT
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Name | LESIA LANGSTON-MCKENNA
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Credential | DMD
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Telephone | 937-393-1472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30024248
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License Number State | OH
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