MEDICARE: MR. ROBERT A LANG JR. 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	122300000X	Dentist	037734	NY

General Provider Information

NPI Number	:	1558451997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT A LANG JR. DDS

Provider Business Mailing Address
First Line	:	1859 LAKE ROAD
Second Line	:
City	:	HAMLIN
State	:	NY
Zip	:	14464
Country	:	US
Telephone Number	:	585-964-2000
Fax Number	:	585-964-5735

Provider Business Practice Location Address
First Line	:	1859 LAKE ROAD
Second Line	:
City	:	HAMLIN
State	:	NY
Zip	:	14464
Country	:	US
Telephone Number	:	585-964-2000
Fax Number	:	585-964-5735

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

Provider Enumeration Date	:	10/14/2006
Last Update Date	:	07/08/2007

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