=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598092058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LISA A. LANGFORD D.D.S., P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2009
-----------------------------------------------------
Last Update Date | 11/04/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1250 MIDDLEBELT
-----------------------------------------------------
City | INKSTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48141-1628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-721-3800
-----------------------------------------------------
Fax | 734-721-4746
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1250 MIDDLEBELT RD
-----------------------------------------------------
City | INKSTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48141-1628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-721-3800
-----------------------------------------------------
Fax | 734-721-4746
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR.
-----------------------------------------------------
Name | DR. LISA A LANGFORD
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 734-721-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 14100
-----------------------------------------------------
License Number State |
-----------------------------------------------------