=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801909593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARLES W. LANGDON, DDS, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 E WENDOVER AVE
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-1228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-275-4747
-----------------------------------------------------
Fax | 336-370-1391
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 EAST WENDOVER AVE.
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES.
-----------------------------------------------------
Name | CHARLES LANGDON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 336-275-4747
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 3286
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------