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General NPI Number Information
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NPI Number | 1659586287
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Entity Type | Organization
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Legal Business Name | J. MONTY LANG, DDS, PA
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 06/05/2012
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Provider Practice Location Address
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Address Line | 913 HOLLAND AVE
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City | PHILADELPHIA
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State | MS
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Zip | 39350-2115
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Country | US
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Telephone | 601-656-7410
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Fax | 601-656-5052
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Provider Business Mailing Address
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Address Line | PO BOX 389
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City | PHILADELPHIA
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State | MS
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Zip | 39350-0389
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Country | US
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Telephone | 601-656-7410
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Fax | 601-656-5052
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Authorized Official
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Title or Position | TREASURER
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Name | MRS. MICHELLE LANG
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Credential |
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Telephone | 601-656-7410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2736-93
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License Number State | MS
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