MEDICARE: MRS. JUDY RENEE LANGSTON RDH

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	124Q00000X	Dental Hygienist	DH4077	TN

General Provider Information

NPI Number	:	1063595676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDY RENEE LANGSTON RDH

Provider Business Mailing Address
First Line	:	605 BEACON HILL LN
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-2044
Country	:	US
Telephone Number	:	615-758-4589
Fax Number	:

Provider Business Practice Location Address
First Line	:	4761 ANDREW JACKSON PKWY
Second Line	:
City	:	HERMITAGE
State	:	TN
Zip	:	37076-1354
Country	:	US
Telephone Number	:	615-885-3525
Fax Number	:	615-885-9767

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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