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General NPI Number Information
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NPI Number | 1972818862
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Entity Type | Individual
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Provider Name | CARREN RUSSELL LANGFORD D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 141 BANKS STA STE 121-122
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7504
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Country | US
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Telephone | 470-288-2169
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Fax |
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Provider Business Mailing Address
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Address Line | 185 ROSCOMMON CT
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City | TYRONE
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State | GA
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Zip | 30290-1881
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Country | US
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Telephone | 404-895-9636
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN014166
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License Number State | GA
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