Provider Demographics
NPI:1083719298
Name:LANGEL, JENNIFER THOMASINA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:THOMASINA
Last Name:LANGEL
Suffix:
Gender:F
Credentials:RDH
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 43
Mailing Address - Street 2:64 MAIN ST RED FEATHER DENTAL CARE
Mailing Address - City:RED FEATHER LAKES
Mailing Address - State:CO
Mailing Address - Zip Code:80545
Mailing Address - Country:US
Mailing Address - Phone:970-881-2007
Mailing Address - Fax:970-416-1072
Practice Address - Street 1:64 MAIN ST
Practice Address - Street 2:
Practice Address - City:RED FEATHER LAKES
Practice Address - State:CO
Practice Address - Zip Code:80545
Practice Address - Country:US
Practice Address - Phone:970-881-2007
Practice Address - Fax:970-416-1072
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2963124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24070343Medicaid