MEDICARE: DR. CORY JOHN LANGE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7851	NV

General Provider Information

NPI Number	:	1053098947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORY JOHN LANGE DMD

Provider Business Mailing Address
First Line	:	8113 EAGLE CLAN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-1453
Country	:	US
Telephone Number	:	661-750-9610
Fax Number	:

Provider Business Practice Location Address
First Line	:	5205 S DURANGO DR STE 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-0179
Country	:	US
Telephone Number	:	702-384-2828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/03/2023

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Directions to “ DR. CORY JOHN LANGE DMD” Practice Location

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