MEDICARE: DR. KENNETH WILLIAM LANGSTON DDS

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	6418	FL

General Provider Information

NPI Number	:	1306059258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH WILLIAM LANGSTON DDS

Provider Business Mailing Address
First Line	:	2000 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1022
Country	:	US
Telephone Number	:	954-941-4410
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1022
Country	:	US
Telephone Number	:	954-941-4410
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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