Provider Demographics
NPI:1003895368
Name:LANGSTON, BRETT RAYMOND (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:RAYMOND
Last Name:LANGSTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 N WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3500
Mailing Address - Country:US
Mailing Address - Phone:706-877-6526
Mailing Address - Fax:
Practice Address - Street 1:1991 N WILLIAMSBURG DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3500
Practice Address - Country:US
Practice Address - Phone:706-877-6526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN01311122300000X
GADN0131111223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics