Provider Demographics
NPI:1043389109
Name:LANGENFELD, JAMES M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:LANGENFELD
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:PO BOX 1295
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-1295
Mailing Address - Country:US
Mailing Address - Phone:229-382-0467
Mailing Address - Fax:229-382-8714
Practice Address - Street 1:1499 KENNEDY RD STE A
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4177
Practice Address - Country:US
Practice Address - Phone:229-382-0467
Practice Address - Fax:229-382-8714
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO075931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA718144OtherUNITED CONCORDIA
GA910230OtherBCBS
GA00049882Medicaid
GA101600Medicaid
GA9184125Medicaid