Provider Demographics
NPI:1023188273
Name:LANGE, KENNETH E (DDS)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:E
Last Name:LANGE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 RIO LINDO AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1808
Mailing Address - Country:US
Mailing Address - Phone:530-345-5111
Mailing Address - Fax:530-898-8544
Practice Address - Street 1:650 RIO LINDO AVE STE 5
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1808
Practice Address - Country:US
Practice Address - Phone:530-345-5111
Practice Address - Fax:530-898-8544
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice