MEDICARE: SKYEVIEW DENTAL, LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1295433654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SKYEVIEW DENTAL, LLC

Provider Business Mailing Address
First Line	:	185 ROSCOMMON CT
Second Line	:
City	:	TYRONE
State	:	GA
Zip	:	30290-1881
Country	:	US
Telephone Number	:	404-895-9636
Fax Number	:

Provider Business Practice Location Address
First Line	:	2844 HIGHWAY 54
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-1026
Country	:	US
Telephone Number	:	678-699-5304
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. CARREN RUSSELL LANGFORD
Credential	:	DDS
Telephone Number	:	678-699-5304

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	02/15/2023

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