Provider Demographics
NPI:1043306160
Name:LANGFORD, THAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:THAD
Middle Name:
Last Name:LANGFORD
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 1:1700 WEST KOCH
Mailing Address - Street 2:STE 1
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-586-4559
Mailing Address - Fax:406-586-0397
Practice Address - Street 1:1700 WEST KOCH
Practice Address - Street 2:STE 1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-586-4559
Practice Address - Fax:406-586-0397
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5512988OtherCHIP
MT110483Medicaid